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General NPI Number Information
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NPI Number | 1386925469
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Entity Type | Individual
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Provider Name | DEIDRA SHONDRECE LOWE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 865 N HIGHLAND AVE NE
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City | ATLANTA
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State | GA
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Zip | 30306-4565
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 865 N HIGHLAND AVE NE
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City | ATLANTA
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State | GA
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Zip | 30306-4565
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Country | US
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Telephone | 404-205-9499
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95030168
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN217191
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN217191
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License Number State | GA
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