Provider Demographics
NPI:1497310650
Name:DEWBERRY, ADRIENNE (LPN)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:406A VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1089
Mailing Address - Country:US
Mailing Address - Phone:404-824-4801
Mailing Address - Fax:
Practice Address - Street 1:715 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2030
Practice Address - Country:US
Practice Address - Phone:770-358-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN072948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse