Provider Demographics
NPI:1497789028
Name:HOUSE, DOROTHY G (RN, BSN)
Entity Type:Individual
Prefix:MISS
First Name:DOROTHY
Middle Name:G
Last Name:HOUSE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 WOODIRON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-3766
Mailing Address - Country:US
Mailing Address - Phone:678-584-0497
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT ROAD
Practice Address - Street 2:3A 179
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146286163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical