Healthcare Provider Details

I. General information

NPI: 1093591059
Provider Name (Legal Business Name): PATRINA PINDER CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N BERKELEY LAKE RD NW APT 321
DULUTH GA
30096-1431
US

IV. Provider business mailing address

2620 N BERKELEY LAKE RD NW APT 321
DULUTH GA
30096-1431
US

V. Phone/Fax

Practice location:
  • Phone: 470-234-8567
  • Fax:
Mailing address:
  • Phone: 470-234-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: