Provider Demographics
NPI:1902619539
Name:DEWAR, JHEANELLE-ANN ELIZABETH (CSFA)
Entity type:Individual
Prefix:
First Name:JHEANELLE-ANN
Middle Name:ELIZABETH
Last Name:DEWAR
Suffix:
Gender:
Credentials:CSFA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 931914
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1914
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:833 CAMPBELL HILL ST NW STE 280
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1162
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA212242246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant