Provider Demographics
NPI:1407846314
Name:PATTON, MARCY LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:LYNN
Last Name:PATTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:LYNN
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:111 WADDELL ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2435
Mailing Address - Country:US
Mailing Address - Phone:404-728-7900
Mailing Address - Fax:404-728-7907
Practice Address - Street 1:1924 CLIFF VALLEY WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2421
Practice Address - Country:US
Practice Address - Phone:404-728-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA097961363LF0000X
UT370502-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840706945171OtherROCKY MOUNTAIN HEALTH PLA
801928Medicare ID - Type Unspecified
S03931Medicare UPIN