Provider Demographics
NPI:1538177290
Name:RIVERCITY REHABILITATION AND SPINE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:RIVERCITY REHABILITATION AND SPINE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-243-7010
Mailing Address - Street 1:2300 13TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2596
Mailing Address - Country:US
Mailing Address - Phone:706-243-7010
Mailing Address - Fax:706-243-7019
Practice Address - Street 1:2300 13TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2596
Practice Address - Country:US
Practice Address - Phone:706-243-7010
Practice Address - Fax:706-243-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0538572084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA729703640AMedicaid
GAGRP6398Medicare PIN
H38331Medicare UPIN