Provider Demographics
NPI:1013243153
Name:DUNN, TIESE HERRINGTON
Entity Type:Individual
Prefix:
First Name:TIESE
Middle Name:HERRINGTON
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 VERNON DR W
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3271
Mailing Address - Country:US
Mailing Address - Phone:706-793-5293
Mailing Address - Fax:
Practice Address - Street 1:2728 VERNON DR W
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3271
Practice Address - Country:US
Practice Address - Phone:706-793-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-25
Last Update Date:2009-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker