Healthcare Provider Details

I. General information

NPI: 1699762419
Provider Name (Legal Business Name): PATRICK A EGBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/23/2024
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 JODECO ROAD SUITE A
MCDONOUGH GA
30253
US

IV. Provider business mailing address

3333 JODECO ROAD SUITE A
MCDONOUGH GA
30253
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-4000
  • Fax: 770-474-8510
Mailing address:
  • Phone: 770-692-4000
  • Fax: 770-474-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number033571
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number033571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: