Individual
PATRICK FONGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4203 WINDFLOWER WAY, BOWIE, MD 20720
(404) 509-1243
Mailing address
7893 SUNVALLEY LN, LITHIA SPRINGS, GA 30122-7816
(404) 509-1243
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
HHA10649
DC
183500000X
Pharmacist
Primary
RPH033470.
GA
374U00000X
Home Health Aide
HHA10649
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH033470
BOARD OF PHARMACY
GA
Enumeration date
11/25/2014
Last updated
12/14/2021
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