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General NPI Number Information
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NPI Number | 1174887814
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Entity Type | Organization
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Legal Business Name | DAVID L PATTERSON, PC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 911 OCEAN BLVD
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-4519
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Country | US
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Telephone | 912-638-2724
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Fax | 912-638-2409
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Provider Business Mailing Address
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Address Line | 911 OCEAN BLVD
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-4519
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Country | US
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Telephone | 912-638-2734
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Fax | 912-638-2409
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. DAVID LEO PATTERSON
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Credential | PHD
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Telephone | 912-638-2724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 000681
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License Number State | GA
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