Provider Demographics
NPI:1386336105
Name:PATTERSON, WILLIAM ODIE IV (FNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ODIE
Last Name:PATTERSON
Suffix:IV
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4842
Mailing Address - Country:US
Mailing Address - Phone:770-228-1181
Mailing Address - Fax:770-228-1182
Practice Address - Street 1:822 S HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4842
Practice Address - Country:US
Practice Address - Phone:770-228-1181
Practice Address - Fax:770-228-1182
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282797363LF0000X
GA2023019873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty