Provider Demographics
NPI:1457424277
Name:PATTERSON, JOHN R
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:PATTERSON
Suffix:
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 1:3160 ROCKINGHAM DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1235
Mailing Address - Country:US
Mailing Address - Phone:404-350-1746
Mailing Address - Fax:404-352-1306
Practice Address - Street 1:6307B ROSWELL RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3209
Practice Address - Country:US
Practice Address - Phone:404-252-8001
Practice Address - Fax:404-252-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4334890001Medicare NSC