Provider Demographics
NPI:1184790024
Name:PATRICIA FOLLETTE
Entity type:Organization
Organization Name:PATRICIA FOLLETTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOLLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-606-9293
Mailing Address - Street 1:30A FOX CHASE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2491
Mailing Address - Country:US
Mailing Address - Phone:770-606-9293
Mailing Address - Fax:770-606-8113
Practice Address - Street 1:30A FOX CHASE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2491
Practice Address - Country:US
Practice Address - Phone:770-606-9293
Practice Address - Fax:770-606-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20015822592332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA888285371BMedicaid
GA388209OtherBC BS
GA888285371BMedicaid