Provider Demographics
NPI:1558762617
Name:DUNWIDDIE, JESSICA L (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DUNWIDDIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 SHORTER AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2042
Mailing Address - Country:US
Mailing Address - Phone:706-233-4000
Mailing Address - Fax:706-233-4006
Practice Address - Street 1:2112 SHORTER AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2042
Practice Address - Country:US
Practice Address - Phone:706-233-4000
Practice Address - Fax:706-233-4006
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209324163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse