Provider Demographics
NPI:1548654098
Name:DEMOSS, PATRICK (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:DEMOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PINE ST STE 520
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7567
Mailing Address - Country:US
Mailing Address - Phone:478-633-2694
Mailing Address - Fax:478-633-4146
Practice Address - Street 1:770 PINE ST STE 520
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7567
Practice Address - Country:US
Practice Address - Phone:478-633-2694
Practice Address - Fax:478-633-4146
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA985422080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology