Provider Demographics
NPI:1841371499
Name:DAWSON, GARY N (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:N
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 13TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0538572084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA304878OtherWELLCARE
GA729703640AMedicaid
GA527031930001OtherBC/BS OF GA
GAH38331Medicare UPIN
GA72BBBBWMedicare ID - Type Unspecified