Provider Demographics
NPI:1710878145
Name:DORIS, PATSY (AGNP)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:
Last Name:DORIS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 SUGARLOAF PKWY STE K
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8836
Mailing Address - Country:US
Mailing Address - Phone:470-227-8130
Mailing Address - Fax:
Practice Address - Street 1:4799 SUGARLOAF PKWY STE K
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8836
Practice Address - Country:US
Practice Address - Phone:470-227-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN292689363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health