Provider Demographics
NPI:1740098623
Name:PATTON, LAKISHIA
Entity type:Individual
Prefix:
First Name:LAKISHIA
Middle Name:
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SWANSON DR STE 111
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8538
Mailing Address - Country:US
Mailing Address - Phone:205-344-1718
Mailing Address - Fax:
Practice Address - Street 1:333 SWANSON DR STE 111
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8538
Practice Address - Country:US
Practice Address - Phone:470-942-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246QL0900X, 246RM2200X, 246Z00000X, 246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other