Provider Demographics
NPI:1417101916
Name:NEALY, PATRICIA LAVERNE
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LAVERNE
Last Name:NEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 MOSSEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-6101
Mailing Address - Country:US
Mailing Address - Phone:229-435-2016
Mailing Address - Fax:229-435-2016
Practice Address - Street 1:133 MOSSEY OAK DRIVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-6101
Practice Address - Country:US
Practice Address - Phone:229-435-2016
Practice Address - Fax:229-435-2016
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055646503172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver