Healthcare Provider Details

I. General information

NPI: 1962408997
Provider Name (Legal Business Name): VERONICA MICHELLE PATTERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

641 HOSPITAL RD SUITE 4
COMMERCE GA
30529-1155
US

IV. Provider business mailing address

641 HOSPITAL RD SUITE 4
COMMERCE GA
30529-1155
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-2777
  • Fax: 706-335-2788
Mailing address:
  • Phone: 706-335-2777
  • Fax: 706-335-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number043107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: