Healthcare Provider Details

I. General information

NPI: 1629035191
Provider Name (Legal Business Name): DAWN C MCCOY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W GORDON ST
THOMASTON GA
30286-3426
US

IV. Provider business mailing address

305 HOWELL ST
THOMASTON GA
30286-5405
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-8111
  • Fax:
Mailing address:
  • Phone: 706-647-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD000831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: