Provider Demographics
NPI:1134127277
Name:BYRNE, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:BYRNE
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 1:801 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5002
Mailing Address - Country:US
Mailing Address - Phone:912-293-1279
Mailing Address - Fax:912-538-7070
Practice Address - Street 1:ONE MEADOWS PARKWAY
Practice Address - Street 2:MEADOWS REGIONAL MEDICAL CENTER
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474
Practice Address - Country:US
Practice Address - Phone:912-538-7777
Practice Address - Fax:912-538-7070
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6027105Medicaid
VA010266891Medicaid
GA202I838063Medicare PIN
VA1346280708Medicare PIN
VAD83928Medicare UPIN
117664N89Medicare ID - Type Unspecified
GA6027105Medicaid