Healthcare Provider Details

I. General information

NPI: 1902298086
Provider Name (Legal Business Name): DORA JEAN-LOUIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 WALTHER RD STE 100
LAWRENCEVILLE GA
30046-8765
US

IV. Provider business mailing address

1700 MEDICAL WAY
SNELLVILLE GA
30078-2195
US

V. Phone/Fax

Practice location:
  • Phone: 770-736-6300
  • Fax:
Mailing address:
  • Phone: 770-979-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN176693
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN176693
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: