Provider Demographics
NPI:1922206317
Name:PATTON, MICHAEL E (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:PATTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 OSLER CT STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0205
Mailing Address - Country:US
Mailing Address - Phone:229-436-8535
Mailing Address - Fax:229-432-1904
Practice Address - Street 1:2402 OSLER CT STE 200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0205
Practice Address - Country:US
Practice Address - Phone:229-436-8535
Practice Address - Fax:229-432-1904
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant