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General NPI Number Information
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NPI Number | 1700760196
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Entity Type | Organization
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Legal Business Name | DYNAMIC MED LLC
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 238 STOCKBRIDGE RD
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City | JONESBORO
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State | GA
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Zip | 30236-3629
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Country | US
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Telephone | 470-908-0226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1404
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City | HAMPTON
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State | GA
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Zip | 30228-0910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ERIKA MCCOWEN
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Credential |
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Telephone | 470-908-0226
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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 |
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License Number State |
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