MEDICARE: MS. YOLANDA DS DAWSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332U00000X	Home Delivered Meals
2	343900000X	Non-emergency Medical Transport (VAN)
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1316543010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YOLANDA DS DAWSON

Provider Business Mailing Address
First Line	:	1911 GRAYSON HWY STE 8-132
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-1245
Country	:	US
Telephone Number	:	470-545-2295
Fax Number	:

Provider Business Practice Location Address
First Line	:	4757 STONE MOUNTAIN HWY
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-4600
Country	:	US
Telephone Number	:	585-576-0639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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