MEDICARE: JOSEPH T PATE JR. PHD

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	103TC0700X	Clinical Psychologist	2391	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	:	1861413494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH T PATE JR. PHD

Provider Business Mailing Address
First Line	:	240 CORPORATE CENTER DR
Second Line	:	SUITE D
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7214
Country	:	US
Telephone Number	:	770-506-8187
Fax Number	:	770-506-7436

Provider Business Practice Location Address
First Line	:	240 CORPORATE CENTER DR
Second Line	:	SUITE D
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7214
Country	:	US
Telephone Number	:	770-506-8187
Fax Number	:	770-506-7436

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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