Provider Demographics
NPI:1639728975
Name:PATTON, JESSICA GRIMES (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRIMES
Last Name:PATTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DANIELLE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:868 YORK AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2750
Mailing Address - Country:US
Mailing Address - Phone:404-752-1400
Mailing Address - Fax:404-755-7400
Practice Address - Street 1:868 YORK AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2750
Practice Address - Country:US
Practice Address - Phone:404-752-1400
Practice Address - Fax:404-755-7400
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3191152W00000X
GAOPT003191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist