Provider Demographics
NPI:1447395173
Name:HAMPTON, PATRICIA WELLBORN (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WELLBORN
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:CAROL
Other - Last Name:WELLBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:ARMUCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:30105-0175
Mailing Address - Country:US
Mailing Address - Phone:706-292-0777
Mailing Address - Fax:706-292-9428
Practice Address - Street 1:5490 MARTHA BERRY HWY NE
Practice Address - Street 2:
Practice Address - City:ARMUCHEE
Practice Address - State:GA
Practice Address - Zip Code:30105-2302
Practice Address - Country:US
Practice Address - Phone:706-292-0777
Practice Address - Fax:706-292-9428
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00326213BMedicaid