Provider Demographics
NPI:1144222456
Name:DORVILUS, PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:DORVILUS
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 1:1601 FAIR RD
Mailing Address - Street 2:STE 500
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1699
Mailing Address - Country:US
Mailing Address - Phone:912-871-3777
Mailing Address - Fax:912-871-3677
Practice Address - Street 1:1497 FAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0822
Practice Address - Country:US
Practice Address - Phone:912-486-1600
Practice Address - Fax:912-871-3342
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60450207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379389Medicaid
CT001379389Medicaid
CT100000353Medicare ID - Type Unspecified