Provider Demographics
NPI:1073795142
Name:KARL, PATRICK THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THOMAS
Last Name:KARL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-7813
Mailing Address - Country:US
Mailing Address - Phone:912-530-7516
Mailing Address - Fax:
Practice Address - Street 1:1907 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7813
Practice Address - Country:US
Practice Address - Phone:912-530-7516
Practice Address - Fax:912-559-6191
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062371207LP2900X
NC2007-01557207LP2900X
GA62371208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA166390878AMedicaid
GA52227920OtherBCBS
GA202I054181Medicare PIN