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Individual

DR. KENNETH W PATRIC JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
403 MCBRIEN RD, EAST RIDGE, TN 37412-3223
(423) 875-0700
Mailing address
2485 BASKETTE WAY, CHATTANOOGA, TN 37421-7615
(423) 240-4829
(615) 425-4271

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
69243
GA
207Q00000X
Family Medicine Physician
Primary
MD0000027485
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
69243
GEORGIA MEDICAL LICENSE
GA
Enumeration date
06/03/2006
Last updated
05/25/2023
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