Healthcare Provider Details

I. General information

NPI: 1841277605
Provider Name (Legal Business Name): PATRICK JOHN ROCKWELL HS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US COAST GUARD AIRSTATION SAVANNAH 1297 NORTH LIGHTNING ROAD HUNTER ARMY AIRFIELD
SAVANNAH GA
31409
US

IV. Provider business mailing address

1016 FORDS POINTE CIR
SAVANNAH GA
31419-8102
US

V. Phone/Fax

Practice location:
  • Phone: 912-652-4646
  • Fax: 912-652-4191
Mailing address:
  • Phone: 912-652-4646
  • Fax: 912-652-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: