Healthcare Provider Details

I. General information

NPI: 1013839448
Provider Name (Legal Business Name): CARMELA L PATTILLO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 HIGHWAY 20 SE
CONYERS GA
30013-2868
US

IV. Provider business mailing address

8451 STONEWALL JACKSON DR
JONESBORO GA
30238-3448
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-4482
  • Fax: 770-922-4640
Mailing address:
  • Phone: 770-922-4482
  • Fax: 770-922-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00115500
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: