Healthcare Provider Details

I. General information

NPI: 1508704610
Provider Name (Legal Business Name): EDDIE LEE DOWDELL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5739 VILLAGE LOOP
FAIRBURN GA
30213-4641
US

IV. Provider business mailing address

5739 VILLAGE LOOP
FAIRBURN GA
30213-4641
US

V. Phone/Fax

Practice location:
  • Phone: 404-409-2512
  • Fax:
Mailing address:
  • Phone: 404-409-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: