Healthcare Provider Details

I. General information

NPI: 1417433798
Provider Name (Legal Business Name): TERRIANO LASHEA DOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 NORTHSIDE DR
MACON GA
31210-2500
US

IV. Provider business mailing address

3312 NORTHSIDE DR
MACON GA
31210-2500
US

V. Phone/Fax

Practice location:
  • Phone: 478-747-2027
  • Fax:
Mailing address:
  • Phone: 478-477-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO078512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: