Healthcare Provider Details

I. General information

NPI: 1356826929
Provider Name (Legal Business Name): DONNA ANNETTE PATTERSON APRN/ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N FANT ST
ANDERSON SC
29621-5708
US

IV. Provider business mailing address

305 BRIGHTON CT
STOCKBRIDGE GA
30281-7131
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-1000
  • Fax:
Mailing address:
  • Phone: 917-242-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN231841
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN231841
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: