Provider Demographics
NPI:1902172232
Name:KNORR, PATRICK RYAN (PA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:KNORR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MERCY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-819-0500
Mailing Address - Fax:912-819-0501
Practice Address - Street 1:602 E 72ND ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4913
Practice Address - Country:US
Practice Address - Phone:912-819-7878
Practice Address - Fax:912-819-7850
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123332DMedicaid
GA02097I1448Medicare PIN
GA202I975878Medicare PIN
GA691202OtherWELLCARE
GA20297I4708Medicare PIN
SC1411PAMedicaid
GA003123332AMedicaid
GAP01110451OtherRAILROAD MEDICARE