Provider Demographics
NPI:1821388638
Name:DUNN, MICHAEL PATRICK (PAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:DUNN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8034
Mailing Address - Country:US
Mailing Address - Phone:404-962-6000
Mailing Address - Fax:404-962-6001
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 480
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8034
Practice Address - Country:US
Practice Address - Phone:404-962-6000
Practice Address - Fax:404-962-6001
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007176363A00000X
GA9917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant