Healthcare Provider Details

I. General information

NPI: 1194697409
Provider Name (Legal Business Name): LASHAYNA D PATTERSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NURSING HOME RD
MARSHALLVILLE GA
31057-3715
US

IV. Provider business mailing address

777 NURSING HOME RD
MARSHALLVILLE GA
31057-3715
US

V. Phone/Fax

Practice location:
  • Phone: 478-967-2223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA005137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: