MEDICARE: DYNAMIC MED LLC

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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1700760196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC MED LLC

Provider Business Mailing Address
First Line	:	PO BOX 1404
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-0910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 STOCKBRIDGE RD
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3629
Country	:	US
Telephone Number	:	470-908-0226
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ERIKA MCCOWEN
Credential	:
Telephone Number	:	470-908-0226

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	10/10/2025

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Directions to “DYNAMIC MED LLC ” Practice Location

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