Provider Demographics
NPI:1932848579
Name:PATTON, TIMOTHY BONNER
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BONNER
Last Name:PATTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 WILLIAMS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3195
Mailing Address - Country:US
Mailing Address - Phone:615-653-4115
Mailing Address - Fax:
Practice Address - Street 1:1608 WILLIAMS DR STE 301
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3195
Practice Address - Country:US
Practice Address - Phone:615-653-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical