Healthcare Provider Details

I. General information

NPI: 1205410230
Provider Name (Legal Business Name): DANA S DUDLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 UNIVERSITY PKWY
AIKEN SC
29801-6310
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 803-306-1438
  • Fax:
Mailing address:
  • Phone: 706-736-1830
  • Fax: 706-650-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000194
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24948
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: