Healthcare Provider Details

I. General information

NPI: 1194964122
Provider Name (Legal Business Name): DAWN GOODFRIEND PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2009
Last Update Date: 02/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 PEACHTREE DUNWOODY RD NE BLDG B-1
ATLANTA GA
30328-1610
US

IV. Provider business mailing address

2515 PLANTERS COVE CIR
LAWRENCEVILLE GA
30044-4487
US

V. Phone/Fax

Practice location:
  • Phone: 866-587-9922
  • Fax:
Mailing address:
  • Phone: 770-277-3268
  • Fax: 770-277-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberA-133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: