Provider Demographics
NPI:1134014657
Name:DZICZKOWSKI, BETH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DZICZKOWSKI
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 1:406 KINGS POINT DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-5210
Mailing Address - Country:US
Mailing Address - Phone:404-966-9296
Mailing Address - Fax:
Practice Address - Street 1:406 KINGS POINT DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-5210
Practice Address - Country:US
Practice Address - Phone:404-966-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264561363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care