Basic Information
| Provider Information | |||||||||
| NPI: | 1285235457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NETTLES | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 294 | ||||||||
| Address2: | |||||||||
| City: | JOHNSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295550294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439929795 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 CASHUA ST | ||||||||
| Address2: | |||||||||
| City: | DARLINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295323301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433937452 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3740 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.