=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760944334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARELIOUS DUNN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2019
-----------------------------------------------------
Last Update Date | 04/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6722 HIGHWAY 85 STE 5
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30274-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-744-9157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6722 HIGHWAY 85 STE 5
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30274-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-744-9157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146M00000X
-----------------------------------------------------
Taxonomy Name | Intermediate Emergency Medical Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------