Basic Information
| Provider Information | |||||||||
| NPI: | 1588621262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GASPARD | ||||||||
| FirstName: | PATRICE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | GASPARD | ||||||||
| OtherFirstName: | PATRICE | ||||||||
| OtherMiddleName: | THERESA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20 GLENLAKE PKWY | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706776037 | ||||||||
| FaxNumber: | 7706777324 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 GLENLAKE PKWY | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043647243 | ||||||||
| FaxNumber: | 7706777324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036749 | GA | X | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | 036749 | GA | X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.