Provider Demographics
NPI:1861629651
Name:CHIMEZIE, PATRICIA I (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:I
Last Name:CHIMEZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-1316
Mailing Address - Fax:912-350-2156
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-1316
Practice Address - Fax:912-350-2156
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068494207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGA1383Medicaid
GAP01106393OtherRAILROAD MEDICARE
GA003127011AMedicaid
01684041OtherAMERIGROUP
710280OtherWELLCARE
GA003127011AMedicaid