Provider Demographics
NPI:1245874718
Name:DAUPHIN, VERNICE M (STUDENT)
Entity type:Individual
Prefix:
First Name:VERNICE
Middle Name:M
Last Name:DAUPHIN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 EAGLES LANDING PKWY STE 234
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7343
Mailing Address - Country:US
Mailing Address - Phone:404-207-7829
Mailing Address - Fax:877-265-6798
Practice Address - Street 1:827 FAIRWAYS CT STE 305
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9068
Practice Address - Country:US
Practice Address - Phone:678-782-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program