Provider Demographics
NPI:1396514402
Name:PATTERSON, JAMIE LEE JR
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N PORTAGE PATH APT 9B6
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-2521
Mailing Address - Country:US
Mailing Address - Phone:330-835-8920
Mailing Address - Fax:
Practice Address - Street 1:1205 MERCER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1303
Practice Address - Country:US
Practice Address - Phone:330-835-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
OHKDA5426172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle