Provider Demographics
NPI:1235776535
Name:PARTIN, DORLETTA MAE
Entity Type:Individual
Prefix:
First Name:DORLETTA
Middle Name:MAE
Last Name:PARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 ETTERLE RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:GA
Mailing Address - Zip Code:30805-3515
Mailing Address - Country:US
Mailing Address - Phone:706-592-6143
Mailing Address - Fax:
Practice Address - Street 1:3421 MIKE PADGETT HWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3815
Practice Address - Country:US
Practice Address - Phone:706-432-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse