Healthcare Provider Details

I. General information

NPI: 1902160930
Provider Name (Legal Business Name): COLLEEN HILL PATTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 10/20/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUCKWALTER PLACE BLVD STE 130
BLUFFTON SC
29910-5023
US

IV. Provider business mailing address

45 HOSPITAL CENTER CMNS
HILTON HEAD ISLAND SC
29926-2837
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-7101
  • Fax: 843-836-7112
Mailing address:
  • Phone: 843-689-2895
  • Fax: 843-689-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103689
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003919
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3565
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: