Provider Demographics
NPI:1811205065
Name:PATTERSON, LEON CALDWELL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:CALDWELL
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-2522
Mailing Address - Country:US
Mailing Address - Phone:229-732-2892
Mailing Address - Fax:229-732-2915
Practice Address - Street 1:101 N WEBSTER ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-2522
Practice Address - Country:US
Practice Address - Phone:229-732-2892
Practice Address - Fax:229-732-2915
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist