Basic Information
| Provider Information | |||||||||
| NPI: | 1225068208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ-FERMIN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | AIMEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4275 JOHNS CREEK PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300249117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784751606 | ||||||||
| FaxNumber: | 6784751615 | ||||||||
| Practice Location | |||||||||
| Address1: | 4275 JOHNS CREEK PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300249117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787750293 | ||||||||
| FaxNumber: | 6787750297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 02/01/2018 | ||||||||
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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 | 207RG0100X | 2006023689 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 073644 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 003159536L | 05 | GA | MEDICAID |