Healthcare Provider Details

I. General information

NPI: 1831186600
Provider Name (Legal Business Name): DALE S. JOWERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDY HILL RD SE SUITE 302
MARIETTA GA
30067-8665
US

IV. Provider business mailing address

3155 N POINT PKWY ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100
ALPHARETTA GA
30005
US

V. Phone/Fax

Practice location:
  • Phone: 678-574-0943
  • Fax: 678-574-0943
Mailing address:
  • Phone: 770-645-9181
  • Fax: 770-645-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN065293
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: