Provider Demographics
NPI:1457342693
Name:PATTEN, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:PATTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 MONTREAL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8146
Mailing Address - Country:US
Mailing Address - Phone:404-446-1340
Mailing Address - Fax:404-446-3497
Practice Address - Street 1:1350 MONTREAL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8146
Practice Address - Country:US
Practice Address - Phone:404-446-1340
Practice Address - Fax:404-446-3497
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041922207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000719562EMedicaid
GA000719562EMedicaid
GA11SCFZSMedicare ID - Type Unspecified