Basic Information
| Provider Information | |||||||||
| NPI: | 1073761797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACDONALD | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | MCGEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 WATERS AVE STE 307 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123507914 | ||||||||
| FaxNumber: | 9129507973 | ||||||||
| Practice Location | |||||||||
| Address1: | 4750 WATERS AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123507914 | ||||||||
| FaxNumber: | 9129507973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2008 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN073225 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0200X | RN073225 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 933355779A | 05 | GA | MEDICAID | 539222 | 01 | GA | WELLCARE | OTHER | 01289425 | 01 | AMERIGROUP | OTHER | P00649645 | 01 | GA | RR MEDICARE | OTHER | NP1628 | 05 | SC | MEDICAID |