Individual
LISA PATTERSON FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
906 N 5TH ST STE D, CORDELE, GA 31015-3224
(229) 271-4630
(229) 271-4631
Mailing address
906 N 5TH ST STE D, CORDELE, GA 31015-3224
(229) 271-4630
(229) 271-4631
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
154242
GA
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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