Provider Demographics
NPI:1275756207
Name:FLEMING, PATRICK M (PA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WOODPARK PL
Mailing Address - Street 2:BLDG. C
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3705
Mailing Address - Country:US
Mailing Address - Phone:770-926-4150
Mailing Address - Fax:770-926-0594
Practice Address - Street 1:203 WOODPARK PL
Practice Address - Street 2:BLDG. C
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3705
Practice Address - Country:US
Practice Address - Phone:770-926-4150
Practice Address - Fax:770-926-0594
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02670363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical