Provider Demographics
NPI:1285000976
Name:DUNN, JASON RANDOLPH (PSYD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RANDOLPH
Last Name:DUNN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:701 BROAD ST
Practice Address - Street 2:STE 350
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3092
Practice Address - Country:US
Practice Address - Phone:762-235-3640
Practice Address - Fax:706-295-2062
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical