Provider Demographics
NPI:1568463404
Name:PATTON, ELIZABETH DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:PATTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2474
Mailing Address - Country:US
Mailing Address - Phone:706-338-0335
Mailing Address - Fax:
Practice Address - Street 1:916 LOGANVILLE HWY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2144
Practice Address - Country:US
Practice Address - Phone:770-307-1637
Practice Address - Fax:770-307-1746
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist