Patrice Gibson Chishom, MD
Individual provider Active NPI Pediatrics Physician · Clarkston, GA
NPI 1366441032 · NPPES record last updated Mar 20, 2022
Key facts
- NPI
- 1366441032
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 045185 (GA)
- Practice address
- 4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106 - Phone
- (404) 289-7133
- Fax
- (404) 289-7211
- NPI assigned
- Jul 15, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045185 | GA | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 045185 | GA | Yes |
Addresses
Primary practice location
4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106
Mailing address
4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106
Phone (404) 289-7133
Other names
- Patrice Dannette Gibson
Other providers in Clarkston, GA
- Alexandra Cesar
- Kourtney Danielle Chang
- Eunice Li Chay
- Huei-Chen Cheng
- Mariya George Cheriyampurathu
- Clarkston Community Health Center, Inc.
- Clarkston Family Medicine
- Clarkston Primary & Urgent Care, LLC
- Marqueta A Coffer
- Corinthianhomwcareservices
All providers in Clarkston, GA · Pediatrics Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.