Provider Demographics
NPI:1497844591
Name:STRATTON, PATRICIA DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DAVID
Last Name:STRATTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:PATRICIA
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:566 MURPHY HWY
Mailing Address - Street 2:SUITE 204B
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3068
Mailing Address - Country:US
Mailing Address - Phone:706-781-1217
Mailing Address - Fax:706-781-1218
Practice Address - Street 1:566 MURPHY HWY
Practice Address - Street 2:SUITE 204B
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3068
Practice Address - Country:US
Practice Address - Phone:706-781-1217
Practice Address - Fax:706-781-1218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00819772BMedicaid
GA000819772AMedicaid
GA00819772BMedicaid
GAP07580Medicare UPIN
GA68BBGWGMedicare PIN