Provider Demographics
NPI:1073761797
Name:MACDONALD, PATTI MCGEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:MCGEE
Last Name:MACDONALD
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 1:4750 WATERS AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-350-7914
Mailing Address - Fax:912-950-7973
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-7914
Practice Address - Fax:912-950-7973
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN073225363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA933355779AMedicaid
GA539222OtherWELLCARE
01289425OtherAMERIGROUP
GAP00649645OtherRR MEDICARE
SCNP1628Medicaid
GA933355779AMedicaid
GA539222OtherWELLCARE