Healthcare Provider Details

I. General information

NPI: 1497789028
Provider Name (Legal Business Name): DOROTHY G. HOUSE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT ROAD 3A 179
ATLANTA GA
30033
US

IV. Provider business mailing address

11202 WOODIRON DR
DULUTH GA
30097-3766
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 678-584-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN146286
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: