Provider Demographics
NPI:1134310998
Name:LOWE, PATRICIA KIM (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KIM
Last Name:LOWE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-5619
Mailing Address - Country:US
Mailing Address - Phone:706-678-6944
Mailing Address - Fax:706-678-6945
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:STE 500
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-5619
Practice Address - Country:US
Practice Address - Phone:706-678-6944
Practice Address - Fax:706-678-6945
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1227363AS0400X
GA06929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003140483CMedicaid