Provider Demographics
NPI:1548659071
Name:DOVE-EDWIN, PHYLLIS BURR
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:BURR
Last Name:DOVE-EDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 LAKEFIELD CT SE STE B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6610
Mailing Address - Country:US
Mailing Address - Phone:404-784-9158
Mailing Address - Fax:
Practice Address - Street 1:1818 LAKEFIELD CT SE STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6610
Practice Address - Country:US
Practice Address - Phone:404-784-9158
Practice Address - Fax:404-203-2421
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN152509163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management