Healthcare Provider Details

I. General information

NPI: 1710070842
Provider Name (Legal Business Name): DORCAS W MWANGI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WINN WAY SUITE 201
DECATUR GA
30030-1753
US

IV. Provider business mailing address

865 N HIGHLAND AVE NE
ATLANTA GA
30306-4565
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-0010
  • Fax: 404-508-0030
Mailing address:
  • Phone: 770-842-8698
  • Fax: 770-842-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN162748
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN162748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: