Healthcare Provider Details

I. General information

NPI: 1952666034
Provider Name (Legal Business Name): EYDIE MORGAN DODYS RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BLDG A
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1809 RIDGEWOOD DR NE
ATLANTA GA
30307-1152
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5892
  • Fax: 404-778-1218
Mailing address:
  • Phone: 770-317-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN066593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: