Provider Demographics
NPI:1043316417
Name:FALL, PATRICIA (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 COMMERCIAL DR
Mailing Address - Street 2:STE 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3639
Mailing Address - Country:US
Mailing Address - Phone:912-355-2335
Mailing Address - Fax:
Practice Address - Street 1:322 COMMERCIAL DR
Practice Address - Street 2:STE 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3639
Practice Address - Country:US
Practice Address - Phone:912-355-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN17983RX363LP0200X
GARN232945363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics