Provider Demographics
NPI:1003914813
Name:PATTON, GEORGE E JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:PATTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4760
Mailing Address - Fax:601-200-4742
Practice Address - Street 1:1050 RIVER OAKS DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9564
Practice Address - Country:US
Practice Address - Phone:601-200-4760
Practice Address - Fax:601-200-4742
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013801Medicaid
MSP00739233OtherRAILROAD MEDICARE
MSP00739233OtherRAILROAD MEDICARE