Provider Demographics
NPI:1437430352
Name:DYER, JULI MICKELLE (FNP)
Entity Type:Individual
Prefix:
First Name:JULI
Middle Name:MICKELLE
Last Name:DYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULI
Other - Middle Name:MICKELLE
Other - Last Name:MANRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1285 SIMS ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3851
Practice Address - Country:US
Practice Address - Phone:770-219-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112747BMedicaid
GA627300OtherWELLCARE
GA0145676OtherAMERIGROUP
GA003112747AMedicaid
GAP01097486OtherMEDICARE RAILROAD
GA713138OtherWELLCARE OAKWOOD
GA713138OtherWELLCARE OAKWOOD