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General NPI Number Information
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NPI Number | 1023714417
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Entity Type | Organization
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Legal Business Name | DUSTY DOWDY NP LLC
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 03/18/2023
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Provider Practice Location Address
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Address Line | 404 BEECHWOOD LN
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City | WOODSTOCK
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State | GA
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Zip | 30189-8111
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Country | US
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Telephone | 678-800-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 404 BEECHWOOD LN
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City | WOODSTOCK
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State | GA
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Zip | 30189-8111
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Country | US
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Telephone | 678-800-1411
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Fax |
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Authorized Official
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Title or Position | NP/PROVIDER
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Name | MATTHEW DUSTIN DOWDY
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Credential | PMHNP
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Telephone | 678-800-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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