MEDICARE: EDDIE LEE DOWDELL JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle
2	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1508704610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDIE LEE DOWDELL JR.

Provider Business Mailing Address
First Line	:	5739 VILLAGE LOOP
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-4641
Country	:	US
Telephone Number	:	404-409-2512
Fax Number	:

Provider Business Practice Location Address
First Line	:	5739 VILLAGE LOOP
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-4641
Country	:	US
Telephone Number	:	404-409-2512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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