Provider Demographics
NPI:1992790380
Name:DAWSON, JOHN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
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 1:7800 CONNER RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3511
Mailing Address - Country:US
Mailing Address - Phone:865-546-1464
Mailing Address - Fax:865-546-0470
Practice Address - Street 1:7800 CONNER RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3511
Practice Address - Country:US
Practice Address - Phone:865-546-1464
Practice Address - Fax:865-546-0470
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN020654207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3053006Medicaid
TNCB9874OtherRAILROAD MEDICARE
3053006Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMB
TNCB9874OtherRAILROAD MEDICARE
TN3053006Medicaid