MEDICARE: DR. SANDRA SIMS PATTERSON PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY000812	GA

General Provider Information

NPI Number	:	1780734640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA SIMS PATTERSON PH.D.

Provider Business Mailing Address
First Line	:	600 W PEACHTREE ST NW
Second Line	:	SUITE 1570
City	:	ATLANTA
State	:	GA
Zip	:	30308-3607
Country	:	US
Telephone Number	:	404-874-9207
Fax Number	:	404-876-4262

Provider Business Practice Location Address
First Line	:	600 W PEACHTREE ST NW
Second Line	:	SUITE 1570
City	:	ATLANTA
State	:	GA
Zip	:	30308-3607
Country	:	US
Telephone Number	:	404-874-9207
Fax Number	:	404-876-4262

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/09/2007

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