Provider Demographics
NPI:1619976578
Name:DUNN, LORI (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 HOLTS FERRY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642
Mailing Address - Country:US
Mailing Address - Phone:717-418-0649
Mailing Address - Fax:706-453-7180
Practice Address - Street 1:1023 HOLTS FERRY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642
Practice Address - Country:US
Practice Address - Phone:717-418-0649
Practice Address - Fax:706-453-7180
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05-00555IL207L00000X, 208VP0000X
GA61966207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14257300003Medicaid
PA14257300003Medicaid
PA114790Medicare ID - Type Unspecified