Provider Demographics
NPI:1235169376
Name:PATTERSON, EUGENE W (MED,LAT,ATC,CAA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:W
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MED,LAT,ATC,CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SHEFFIELD CHASE
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5935
Mailing Address - Country:US
Mailing Address - Phone:770-898-3403
Mailing Address - Fax:
Practice Address - Street 1:1662 RUGBY AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-2116
Practice Address - Country:US
Practice Address - Phone:404-765-4062
Practice Address - Fax:404-765-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0002762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer