Provider Demographics
NPI:1891751178
Name:DEWBERRY, KERRY G (WHNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:G
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 HOSPITAL DR NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:770-385-8954
Mailing Address - Fax:770-385-8590
Practice Address - Street 1:4181 HOSPITAL DR NE
Practice Address - Street 2:SUITE 104
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-385-8954
Practice Address - Fax:770-385-8590
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172870363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP85564Medicare UPIN
GAON47340Medicare ID - Type Unspecified