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General NPI Number Information
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NPI Number | 1124363577
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Entity Type | Individual
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Provider Name | TERRI TONISHA VAN DORN NP (ACNP-BC)
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Gender | Female
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 1901 HONEY CREEK COMMONS SE
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City | CONYERS
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State | GA
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Zip | 30013-5806
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Country | US
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Telephone | 678-413-3752
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Fax | 678-413-3751
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Provider Business Mailing Address
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Address Line | 497 WINN WAY SUITE A-20
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City | DECATUR
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State | GA
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Zip | 30030-1712
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Country | US
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Telephone | 404-294-7033
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Fax | 404-296-4661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN195252
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN195252
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN195252
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License Number State | GA
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