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General NPI Number Information
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NPI Number | 1871470989
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Entity Type | Individual
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Provider Name | KATELYN PATTERSON LDO
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 414 S MAIN ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3676
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Country | US
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Telephone | 706-871-6881
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Fax |
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Provider Business Mailing Address
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Address Line | 331 CONLEY ST
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City | PORTAL
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State | GA
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Zip | 30450-4122
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Country | US
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Telephone |
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO002963
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License Number State | GA
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