MEDICARE: MARCY LYNN PATTON FNP

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	363LF0000X	Family Nurse Practitioner	097961	GA
2	363L00000X	Nurse Practitioner	370502-4405	UT

General Provider Information

NPI Number	:	1407846314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCY LYNN PATTON FNP

Provider Business Mailing Address
First Line	:	111 WADDELL ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2435
Country	:	US
Telephone Number	:	404-728-7900
Fax Number	:	404-728-7907

Provider Business Practice Location Address
First Line	:	1924 CLIFF VALLEY WAY NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2421
Country	:	US
Telephone Number	:	404-728-7900
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	05/18/2022

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