Provider Demographics
NPI:1790469724
Name:DENNIS, IVEY W (RN)
Entity Type:Individual
Prefix:
First Name:IVEY
Middle Name:W
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IVEY
Other - Middle Name:ELIZABETH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2584 WINDING LN NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3230
Mailing Address - Country:US
Mailing Address - Phone:229-322-0251
Mailing Address - Fax:
Practice Address - Street 1:975 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1619
Practice Address - Country:US
Practice Address - Phone:404-256-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248376163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery