Provider Demographics
NPI:1316926058
Name:PATTERSON, PICKENS ANDREW III (MD)
Entity type:Individual
Prefix:
First Name:PICKENS
Middle Name:ANDREW
Last Name:PATTERSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1388A WELLBROOK CIR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3872
Mailing Address - Country:US
Mailing Address - Phone:678-733-9666
Mailing Address - Fax:404-344-6575
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW
Practice Address - Street 2:STE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5589
Practice Address - Country:US
Practice Address - Phone:678-733-9666
Practice Address - Fax:404-344-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC23964174400000X
GA057737208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH88902Medicare UPIN
GA05BDLDFMedicare PIN