Provider Demographics
NPI:1083612501
Name:KEARNS, PATRICK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:KEARNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 RUSH CHAPEL RD NE
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-5030
Mailing Address - Country:US
Mailing Address - Phone:706-232-4213
Mailing Address - Fax:706-295-6514
Practice Address - Street 1:311 W 8TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2723
Practice Address - Country:US
Practice Address - Phone:706-291-8702
Practice Address - Fax:706-291-6514
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028022207ZP0102X
AL13929207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00345958AMedicaid
GA00345958AMedicaid
GA22CDBJKMedicare ID - Type UnspecifiedMEDICARE PROVIDER SEP GA