Provider Demographics
NPI:1124363577
Name:VAN DORN, TERRI TONISHA (NP (ACNP-BC))
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:TONISHA
Last Name:VAN DORN
Suffix:
Gender:F
Credentials:NP (ACNP-BC)
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:TONISHA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP (ACNP-BC)
Mailing Address - Street 1:497 WINN WAY
Mailing Address - Street 2:SUITE A-20
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1712
Mailing Address - Country:US
Mailing Address - Phone:404-294-7033
Mailing Address - Fax:404-296-4661
Practice Address - Street 1:1901 HONEY CREEK COMMONS SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5806
Practice Address - Country:US
Practice Address - Phone:678-413-3752
Practice Address - Fax:678-413-3751
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195252363L00000X, 363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health