Provider Demographics
NPI:1396990990
Name:DORTCH, JANET A (NP)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:A
Last Name:DORTCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 MARK HALL DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5342
Mailing Address - Country:US
Mailing Address - Phone:770-565-1276
Mailing Address - Fax:
Practice Address - Street 1:105 COLLIER RD NW
Practice Address - Street 2:SUITE 1080
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-352-2850
Practice Address - Fax:404-352-0947
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130308163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice