Healthcare Provider Details

I. General information

NPI: 1629066915
Provider Name (Legal Business Name): PATRICIA FAYE PATTERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 VAN STREAT HWY
NICHOLLS GA
31554-5025
US

IV. Provider business mailing address

302 S WAYNE ST
ALMA GA
31510-2922
US

V. Phone/Fax

Practice location:
  • Phone: 912-345-2474
  • Fax: 912-345-5620
Mailing address:
  • Phone: 912-632-8961
  • Fax: 912-632-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number031176
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: