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General NPI Number Information
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NPI Number | 1336115674
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Entity Type | Individual
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Provider Name | MARY ELIZABETH PATRENOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 3312 HENRY RD
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City | ANNISTON
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State | AL
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Zip | 36207-6344
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Country | US
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Telephone | 256-241-2671
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Fax | 256-241-2676
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Provider Business Mailing Address
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Address Line | 3312 HENRY RD
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City | ANNISTON
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State | AL
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Zip | 36207-6344
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Country | US
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Telephone | 256-241-2671
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Fax | 256-241-2676
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 037042
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 14173
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License Number State | AL
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