Provider Demographics
NPI:1386925469
Name:LOWE, DEIDRA SHONDRECE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:SHONDRECE
Last Name:LOWE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9202 KENSINGTON TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3257
Mailing Address - Country:US
Mailing Address - Phone:601-874-3632
Mailing Address - Fax:
Practice Address - Street 1:1253 BROOKSTONE CIR
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-0327
Practice Address - Country:US
Practice Address - Phone:404-205-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217191163W00000X
GA95030168363LF0000X
CA95030168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse