Douglass, Deirdre Dolan

Douglass, Deirdre Dolan is an sole proprietor health care provider with primary practice located at 586 Clubland Cir Se , Conyers GA 30094-3626. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Douglass, Deirdre Dolan can be contacted via phone (770) 785-7908.

Contact Information

Primary practice address
586 Clubland Cir Se Conyers GA 30094-3626
Phone: (770) 785-7908
Fax: (770) 785-7908
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 2251P0200X PT003272 Georgia

Profile Details

NPI number 1598825747
LBN Legal business name Douglass, Deirdre Dolan
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 11th, 2006
Last updated Sep 17th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598825747 NPPES
Georgia MEDICAID 322094
Georgia MEDICAID 000711763B
Georgia MEDICAID 10057878

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