Provider Demographics
NPI:1194964122
Name:GOODFRIEND, DAWN (PTA)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:GOODFRIEND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 PLANTERS COVE CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4487
Mailing Address - Country:US
Mailing Address - Phone:770-277-3268
Mailing Address - Fax:770-277-3268
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD NE BLDG B-1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1610
Practice Address - Country:US
Practice Address - Phone:866-587-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA-133251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care