1184713216 NPI number — DUNAMIS, INC

Table of content: (NPI 1184713216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184713216 NPI number — DUNAMIS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNAMIS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184713216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3545 CRUSE RD
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30044-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-279-1144
Provider Business Mailing Address Fax Number:
770-279-0809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3545 CRUSE RD.
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30044-3171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-279-1144
Provider Business Practice Location Address Fax Number:
770-279-0809
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SATTERFIELD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-279-1144

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  2006015905 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00701005A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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