MEDICARE: LAVORIA PATTERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN128730	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326619156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVORIA PATTERSON

Provider Business Mailing Address
First Line	:	2989 WILSONE PL
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-6150
Country	:	US
Telephone Number	:	770-685-0718
Fax Number	:	770-696-1423

Provider Business Practice Location Address
First Line	:	2989 WILSONE PL
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-6150
Country	:	US
Telephone Number	:	770-685-0718
Fax Number	:	770-696-1423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	07/02/2021

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Directions to “ LAVORIA PATTERSON ” Practice Location

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