Provider Demographics
NPI:1770824187
Name:PATTON, STEPHANIA ALTHEA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIA
Middle Name:ALTHEA
Last Name:PATTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SUNFLOWER MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3712
Mailing Address - Country:US
Mailing Address - Phone:678-697-5175
Mailing Address - Fax:
Practice Address - Street 1:136 SUNFLOWER MEADOWS DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3712
Practice Address - Country:US
Practice Address - Phone:678-697-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171543163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse