Individual
SAMUEL PATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1125 CARLYSLE PARK DR, LAWRENCEVILLE, GA 30044-2241
(678) 467-6605
Mailing address
1125 CARLYSLE PARK DR, LAWRENCEVILLE, GA 30044-2241
(678) 467-6605
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699133918
171W00000X
GA
Enumeration date
02/01/2016
Last updated
02/02/2016
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