Healthcare Provider Details

I. General information

NPI: 1942112347
Provider Name (Legal Business Name): JOHNNIE A PATTERSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 RIVER RD
COLUMBUS GA
31904-2316
US

IV. Provider business mailing address

2400 HOSPITAL RD
TUSKEGEE AL
36083-5001
US

V. Phone/Fax

Practice location:
  • Phone: 706-257-7200
  • Fax:
Mailing address:
  • Phone: 334-727-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-106281
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: