Healthcare Provider Details

I. General information

NPI: 1427691906
Provider Name (Legal Business Name): GRIFFIN PATTERSON MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CLEARFIELD AVE
VIRGINIA BEACH VA
23462-1832
US

IV. Provider business mailing address

618 CEDAR SPRINGS CT
VIRGINIA BEACH VA
23462-7115
US

V. Phone/Fax

Practice location:
  • Phone: 860-992-7587
  • Fax:
Mailing address:
  • Phone: 860-992-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2857
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-4664
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126004130
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: