Basic Information
| Provider Information | |||||||||
| NPI: | 1356826929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | APRN/ NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 BRIGHTON CT | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302817131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172421319 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 N FANT ST | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296215708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645121000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2018 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN231841 | GA | N | Nursing Service Providers | Registered Nurse | General Practice | 363L00000X | RN231841 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.