Provider Demographics
NPI:1184822967
Name:DRURY, DAWNA WYDRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAWNA
Middle Name:WYDRA
Last Name:DRURY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 THUNDER GULCH PASS
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5444
Mailing Address - Country:US
Mailing Address - Phone:678-613-5384
Mailing Address - Fax:
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:STE. 1101
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:470-239-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0021461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I800016Medicare UPIN