Provider Demographics
NPI:1447285176
Name:BIRD, PATRICIA ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:BIRD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 ZOAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6134
Mailing Address - Country:US
Mailing Address - Phone:770-979-1818
Mailing Address - Fax:770-736-7134
Practice Address - Street 1:3725 ZOAR RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6134
Practice Address - Country:US
Practice Address - Phone:770-979-1818
Practice Address - Fax:770-736-7134
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000808024BMedicaid
GA05BBJHBMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID