1497844591 NPI number — DR. PATRICIA DAVID STRATTON PH.D.

Table of content: DR. PATRICIA DAVID STRATTON PH.D. (NPI 1497844591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497844591 NPI number — DR. PATRICIA DAVID STRATTON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRATTON
Provider First Name:
PATRICIA
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVID
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497844591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
566 MURPHY HWY
Provider Second Line Business Mailing Address:
SUITE 204B
Provider Business Mailing Address City Name:
BLAIRSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30512-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-781-1217
Provider Business Mailing Address Fax Number:
706-781-1218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
566 MURPHY HWY
Provider Second Line Business Practice Location Address:
SUITE 204B
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30512-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-781-1217
Provider Business Practice Location Address Fax Number:
706-781-1218
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY002300 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00819772B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000819772A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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