Provider Demographics
NPI:1023714417
Name:DUSTY DOWDY NP LLC
Entity type:Organization
Organization Name:DUSTY DOWDY NP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DUSTIN
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:678-800-1411
Mailing Address - Street 1:404 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8111
Mailing Address - Country:US
Mailing Address - Phone:678-800-1411
Mailing Address - Fax:
Practice Address - Street 1:404 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8111
Practice Address - Country:US
Practice Address - Phone:678-800-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1295382125OtherNPI