Healthcare Provider Details

I. General information

NPI: 1922157247
Provider Name (Legal Business Name): DARLENE L DOTSON CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LACY STREET SUITE A
MAREITTA GA
30060
US

IV. Provider business mailing address

1454 DEVON MILL WAY
AUSTELL GA
30168
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1985
  • Fax: 770-422-2814
Mailing address:
  • Phone: 770-739-6175
  • Fax: 770-422-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN088140
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: