Kenneth W Patric Jr., MD
Individual provider Active NPI Family Medicine Physician · East Ridge, TN
NPI 1366480014 · NPPES record last updated May 25, 2023
Key facts
- NPI
- 1366480014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD0000027485 (TN)
- Practice address
- 403 McBrien Rd
East Ridge, TN 37412-3223 - Phone
- (423) 875-0700
- NPI assigned
- Jun 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in TN, KY, AZ, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070425000692 | TN | Practitioner - Family Practice | 8123124823 | Reassigns benefits to 2 organizations |
| I20121110000040 | KY | Practitioner - Family Practice | 8123124823 | Reassigns benefits to 1 organization |
| I20121116000265 | AZ | Practitioner - Family Practice | 8123124823 | Reassigns benefits to 1 organization |
| I20130628000015 | GA | Practitioner - Family Practice | 8123124823 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69243 | GA | MD | Family Medicine Physician |
| MD0000027485 | TN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kiosk Medicine Kentucky LLC | Current |
Accepting new patients | |
| The Little Clinic of Arizona LLC | Current |
Accepting new patients | |
| The Little Clinic of Tennessee LLC | Current |
Accepting new patients | |
| Little Clinic of Mississippi LLC | Current | Accepting new patients | |
| TLC of Georgia LLC | Current |
Accepting new patients | |
| Crossroads Urgent Care PLLC | Family Medicine | Current |
Accepting new patients |
| Primary Health Care Center of Dade, Inc. | Current |
Accepting new patients | |
| Primary Health Care Center of Dade, Inc. | Current |
Accepting new patients | |
| Crossroads Urgent Care PLLC | Family Medicine | Current |
Accepting new patients |
| Primary Health Care Center of Dade, Inc. | Current | Accepting new patients |
Locations
2727 W Bell Rd
Phoenix, AZ 85053
Phone (602) 680-2386
774 Highway 96
Bonaire, GA 31005
Phone (478) 988-5711
455 Nathan Dean Blvd
Dallas, GA 30132
Phone (770) 443-8776
2009 Old Lafayette Rd
Ft Oglethorpe, GA 30742
Phone (706) 861-5950
3600 Dallas Hwy SW
Marietta, GA 30064
Phone (770) 420-9170
13570 N Main St
#0
Trenton, GA 30752
13570 N Main St
Trenton, GA 30752
Phone (404) 657-7575
3039 Breckenridge Ln
Louisville, KY 40220
Phone (502) 451-4555
9080 Taylorsville Rd
Louisville, KY 40299
Phone (502) 491-8805
2021 Hamilton Place Blvd
Chattanooga, TN 37421
Phone (423) 855-9285
2021 Hamilton Place Blvd
Ste G
Chattanooga, TN 37421
Phone (423) 899-6222
4747 Highway 58
Chattanooga, TN 37416
Phone (423) 648-4500
403 McBrien Rd
East Ridge, TN 37412
Phone (423) 875-0700
4490 Hixson Pike
Hixson, TN 37343
Phone (423) 875-0700
189 Brooklawn St
Knoxville, TN 37934
Phone (865) 392-9136
2449 Old Fort Pkwy
Murfreesboro, TN 37128
Phone (615) 225-0140
2445 Memorial Blvd
Ste C
Murfreesboro, TN 37129
Phone (615) 217-6900
2620 Elm Hill Pike
Nashville, TN 37214
Phone (615) 425-4211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 69243 | GA | |
| Family Medicine Physician | 207Q00000X | MD0000027485 | TN | Yes |
Addresses
Primary practice location
403 McBrien Rd
East Ridge, TN 37412-3223
Mailing address
2485 Baskette Way
Chattanooga, TN 37421-7615
Phone (423) 240-4829
Other practice location 1
2009 Old Lafayette Rd
Fort Oglethorpe, GA 30742-3510
Phone (706) 866-5520
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 69243 | Other | GA | GEORGIA MEDICAL LICENSE |
Other providers in East Ridge, TN
- Ruth A Nielson
- Nathaniel Graham Norman
- Kurtisha Norris
- Jancy Allison Parkerson
- Kalpeshkumar Rameshbhai Patel
- Bruce Allen Pendley
- Carlina Lopez Pendon
- Tessa K Poteralski
- Puckett Emergency Medical Services, LLC
- Puckett Med Van LLC
All providers in East Ridge, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.