Individual
JILL MELAINE PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
50 PLAZA WAY NW STE E, MARIETTA, GA 30060-1141
(770) 732-5101
(770) 974-3955
Mailing address
4295 COUNTRY GARDEN WALK NW, KENNESAW, GA 30152-2399
(770) 235-2462
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
RN128940
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003130618A
—
GA
Enumeration date
02/13/2012
Last updated
03/17/2018
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