Shontiaya S. Patterson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN219785 Issued in GA

Practice address

1324 Highway 138 SW
Riverdale, GA 30296-1404

Phone

(770) 907-4949

Fax

(770) 907-4022

NPI assigned

Sep 19, 2012

Last updated

Dec 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Love and Care

  dba Legacy

  • Community/Behavioral Health Agency
  • Jonesboro, GA
  • NPI 1760276331
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1063762870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 WATKINS GLEN DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302524061",
            "telephone_number": "770-309-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 HIGHWAY 138 SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302961404",
            "telephone_number": "770-907-4949",
            "fax_number": "770-907-4022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Gwinnett Dr",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300468444",
            "country_code": "US",
            "telephone_number": "770-339-2395",
            "fax_number": "678-990-3997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "559 Flat Shoals Ave SE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303162027",
            "country_code": "US",
            "telephone_number": "770-907-4949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "SHONTIAYA",
        "middle_name": "S.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN219785",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "RN219785",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nimish Patel
• Prachi Sanjaykumar Patel, MD
• Pathlink of Georgia LLC
• Pathologists at Riverdale PC
• Pathways to Recovery Associates Inc.
• Paul H Liebman MD PC
• Dawn A. Paul, FNP-C
• April Paulk, CPT, CNA
• Payless Taxi & Shuttle Services Inc. (Payless Taxi & Shuttle.)
• Payless Taxi & Shuttle Services Inc.

• Family Nurse Practitioner in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.