Healthcare Provider Details

I. General information

NPI: 1033743455
Provider Name (Legal Business Name): DANA ELIZABETH TOTH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BOWMAN RD
MACON GA
31210
US

IV. Provider business mailing address

111 WHITE TAIL LN
WARNER ROBINS GA
31088-2799
US

V. Phone/Fax

Practice location:
  • Phone: 478-239-1043
  • Fax:
Mailing address:
  • Phone: 478-951-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN106890
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: