Healthcare Provider Details

I. General information

NPI: 1770242117
Provider Name (Legal Business Name): NIYONU MCDOWELL-WHARTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 PEACHTREE RD NE # 115
ATLANTA GA
30326-1881
US

IV. Provider business mailing address

PO BOX 9042
GREENVILLE SC
29604-9042
US

V. Phone/Fax

Practice location:
  • Phone: 864-907-4525
  • Fax:
Mailing address:
  • Phone: 864-907-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberPHCP011327
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: