Provider Demographics
NPI:1144593906
Name:DUNAVAN, TERENCE ALAN (LPN)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:ALAN
Last Name:DUNAVAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 PENDLETON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4840
Mailing Address - Country:US
Mailing Address - Phone:706-726-5663
Mailing Address - Fax:
Practice Address - Street 1:1506 PENDLETON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4840
Practice Address - Country:US
Practice Address - Phone:706-726-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN073147164W00000X
SC43932164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse