Healthcare Provider Details

I. General information

NPI: 1952412736
Provider Name (Legal Business Name): DOROTHY SMITH DUNN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

6050 COLUMBIA RD
GROVETOWN GA
30813-5111
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-7905
  • Fax: 706-432-3780
Mailing address:
  • Phone: 706-541-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN089253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: