Healthcare Provider Details

I. General information

NPI: 1013424803
Provider Name (Legal Business Name): RANDY E PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110A DOVER RD
GREENSBORO NC
27408-7314
US

IV. Provider business mailing address

10 INDIGO LAKE TER UNIT D
GREENSBORO NC
27455-1438
US

V. Phone/Fax

Practice location:
  • Phone: 607-229-2123
  • Fax:
Mailing address:
  • Phone: 607-229-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5494
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: