Provider Demographics
NPI:1932235900
Name:PATTERSON, LANCING C (MD)
Entity Type:Individual
Prefix:
First Name:LANCING
Middle Name:C
Last Name:PATTERSON
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 1:380 HOSPITAL DR
Mailing Address - Street 2:STE 320
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8001
Mailing Address - Country:US
Mailing Address - Phone:478-742-5331
Mailing Address - Fax:478-750-1387
Practice Address - Street 1:380 HOSPITAL DR
Practice Address - Street 2:STE 320
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8001
Practice Address - Country:US
Practice Address - Phone:478-742-5331
Practice Address - Fax:478-750-1387
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035971208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACL8455OtherRAILROAD MEDICARE GPR #
GA340007314OtherRAILROAD MEDICARE
GA000516502AMedicaid
GA573313OtherBLUE SHIELD