Healthcare Provider Details

I. General information

NPI: 1619858081
Provider Name (Legal Business Name): CLARE ALANE DYKEWICZ MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2486 SUSALEEN CT NE
ATLANTA GA
30345-3965
US

IV. Provider business mailing address

2486 SUSALEEN CT NE
ATLANTA GA
30345-3965
US

V. Phone/Fax

Practice location:
  • Phone: 404-668-5780
  • Fax:
Mailing address:
  • Phone: 404-668-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32174
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number32174
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: