Provider Demographics
NPI:1821656927
Name:PATMON, ALLEN KAREEM
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:KAREEM
Last Name:PATMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 REESHEMAH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1642
Mailing Address - Country:US
Mailing Address - Phone:678-777-8207
Mailing Address - Fax:
Practice Address - Street 1:4208 REESHEMAH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-1642
Practice Address - Country:US
Practice Address - Phone:678-777-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist