Patrice Gibson Chishom, MD

Pediatrics Physician · Clarkston, GA

Individual Active NPI

NPI number 1366441032

Practice location

4112 E Ponce De Leon Ave
Clarkston, GA 30021-8106
Phone
(404) 289-7133
Fax
(404) 289-7211

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NPI record

NPI
1366441032
Entity type
Individual (Type 1)
Enumeration date
July 15, 2005
Last updated
March 20, 2022
Certified
March 20, 2022
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatrics Physician Primary 208000000X 045185 GA

About Dr. Chishom

Patrice Gibson Chishom, MD is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatrics Physician (code 208000000X). The practice location is 4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106. The NPI number 1366441032 was assigned on July 15, 2005 and the record was last updated on March 20, 2022.

Dr. Chishom lists a license in the registry: #045185 (GA) for Pediatrics Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Patrice Gibson Chishom, MD?

The NPI number is 1366441032.

What is the phone number of Dr. Chishom?

The phone number listed for the practice location is (404) 289-7133.

Where is Dr. Chishom located?

4112 E Ponce De Leon Ave, Clarkston, GA 30021-8106.

What is the taxonomy code for Dr. Chishom?

The primary taxonomy code is 208000000X – Pediatrics Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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