Provider Demographics
NPI:1619034584
Name:ADKINS, PATRICIA KIELEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KIELEY
Last Name:ADKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PAUL BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-1965
Mailing Address - Country:US
Mailing Address - Phone:706-245-1047
Mailing Address - Fax:706-245-1854
Practice Address - Street 1:613 COOK STREET
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662
Practice Address - Country:US
Practice Address - Phone:706-245-1867
Practice Address - Fax:706-245-1854
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002409103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10049164OtherAMERIGROUP PROVIDERNUMBER