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General NPI Number Information
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NPI Number | 1578073565
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Entity Type | Individual
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Provider Name | DAWNE R MICHAEL MSN, AGPCNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 304 SHORTER AVE NW STE 101
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City | ROME
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State | GA
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Zip | 30165-4289
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Country | US
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Telephone | 706-291-3700
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Fax | 706-509-3493
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Provider Business Mailing Address
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Address Line | 5062 HAMBY RD NW
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City | ACWORTH
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State | GA
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Zip | 30102-3534
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Country | US
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Telephone | 404-663-8998
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 205509
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License Number State | GA
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