Healthcare Provider Details

I. General information

NPI: 1487886230
Provider Name (Legal Business Name): MONIQUE DUNBAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE GORDON NP

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 SPICY CEDAR LN
LITHONIA GA
30038-7162
US

IV. Provider business mailing address

3236 SPICY CEDAR LN
LITHONIA GA
30038-7162
US

V. Phone/Fax

Practice location:
  • Phone: 404-780-3096
  • Fax:
Mailing address:
  • Phone: 404-780-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220631
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN220631
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number547838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: