Provider Demographics
NPI:1073879524
Name:NOWELL, DELORES WRIGHT (CPS)
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:WRIGHT
Last Name:NOWELL
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 APPLEWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5033
Mailing Address - Fax:706-370-7749
Practice Address - Street 1:180 WATER OAK DR
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2095
Practice Address - Country:US
Practice Address - Phone:770-748-2225
Practice Address - Fax:770-748-3533
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator