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General NPI Number Information
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NPI Number | 1013839448
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Entity Type | Individual
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Provider Name | CARMELA L PATTILLO LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 3430 HIGHWAY 20 SE
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City | CONYERS
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State | GA
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Zip | 30013-2868
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Country | US
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Telephone | 770-922-4482
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Fax | 770-922-4640
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Provider Business Mailing Address
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Address Line | 8451 STONEWALL JACKSON DR
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City | JONESBORO
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State | GA
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Zip | 30238-3448
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Country | US
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Telephone | 770-922-4482
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Fax | 770-922-4640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00115500
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License Number State | GA
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