Provider Demographics
NPI:1508975269
Name:PATTON, ROBERT MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARION
Last Name:PATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6525
Mailing Address - Country:US
Mailing Address - Phone:706-322-5511
Mailing Address - Fax:706-322-6010
Practice Address - Street 1:4403 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6525
Practice Address - Country:US
Practice Address - Phone:706-322-5511
Practice Address - Fax:706-322-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17258207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0099006645Medicaid
GA034140OtherBC/BS
GAGRP2151OtherMEDICARE COLUMBUS DIAGNOSTIC CENTER GROUP NUMBER
GA00093079AMedicaid
AL60010482OtherBC/BS
GA47BBBFQOtherCOLUMBUS DIAGNOSTIC CENTER, IDTF
GA47BBBFQOtherCOLUMBUS DIAGNOSTIC CENTER, IDTF