Provider Demographics
NPI:1518989433
Name:OWENS, DWIGHT ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:ANTONIO
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:PEACHTREE 25TH BUILDING STE 924
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2451
Mailing Address - Country:US
Mailing Address - Phone:404-575-4785
Mailing Address - Fax:404-575-4786
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2451
Practice Address - Country:US
Practice Address - Phone:404-575-4785
Practice Address - Fax:404-575-4786
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0431052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00851309AMedicaid
GA00851309AMedicaid
GA26BDHBDMedicare ID - Type Unspecified