Provider Demographics
NPI:1700035797
Name:IRWIN, DANA BUCK (NP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BUCK
Last Name:IRWIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 HIGHWAY 129 N
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2652
Mailing Address - Country:US
Mailing Address - Phone:706-367-1010
Mailing Address - Fax:706-367-1050
Practice Address - Street 1:2610 HIGHWAY 129 N
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2652
Practice Address - Country:US
Practice Address - Phone:706-367-1010
Practice Address - Fax:706-367-1050
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129153363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1336411347Medicaid
GA000875938BMedicaid