Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 040978 | GA |
Y | 207VX0201X | Gynecologic Oncologist | 040978 | GA |
NPI | 1306846845 |
---|---|
Provider Name | Roland A Pattillo |
First Address | Atlanta, GA 30303-2544 |
Second Address | Atlanta, GA 30303-3031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000688113 | (05) | GA |
B55627 | (02) |