Provider Demographics
NPI:1164583126
Name:PATINO, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:PATINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3193 HOWELL MILL ROAD NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:404-352-1223
Mailing Address - Fax:404-352-1226
Practice Address - Street 1:3193 HOWELL MILL ROAD NW
Practice Address - Street 2:SUITE 204
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-352-1223
Practice Address - Fax:404-352-1226
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA039435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA039435OtherSTATE OF GA
GA08BDPPMMedicare ID - Type Unspecified
F17410Medicare UPIN