Provider Demographics
NPI:1184729782
Name:PATTERSON, KIRBY ELWOOD (ATC)
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:ELWOOD
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 POPLAR TENT RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6527
Mailing Address - Country:US
Mailing Address - Phone:704-786-8455
Mailing Address - Fax:
Practice Address - Street 1:4390 POPLAR TENT RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6527
Practice Address - Country:US
Practice Address - Phone:704-786-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0125171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor