Provider Demographics
NPI:1093709453
Name:SIEFFERMAN, PATRICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SIEFFERMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12192 AUGUSTA RD
Mailing Address - Street 2:12192 AUGUSTA ROAD
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-1209
Mailing Address - Country:US
Mailing Address - Phone:706-356-1072
Mailing Address - Fax:706-356-1457
Practice Address - Street 1:901 W GREENWOOD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5717
Practice Address - Country:US
Practice Address - Phone:864-366-9938
Practice Address - Fax:864-366-0818
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27377363LF0000X
SC17559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000733048IJKMedicaid
GAS31495Medicare UPIN
GA000733048IJKMedicaid
SC3255Medicare PIN