Healthcare Provider Details

I. General information

NPI: 1144593906
Provider Name (Legal Business Name): TERENCE ALAN DUNAVAN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 PENDLETON RD
AUGUSTA GA
30904-4840
US

IV. Provider business mailing address

1506 PENDLETON RD
AUGUSTA GA
30904-4840
US

V. Phone/Fax

Practice location:
  • Phone: 706-726-5663
  • Fax:
Mailing address:
  • Phone: 706-726-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN073147
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number43932
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: