Healthcare Provider Details

I. General information

NPI: 1023792991
Provider Name (Legal Business Name): KEVONNE KAMOY O'BRIEN DAWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E PINETREE BLVD STE A
THOMASVILLE GA
31792-4875
US

IV. Provider business mailing address

2705 E PINETREE BLVD STE A
THOMASVILLE GA
31792-4875
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-4136
  • Fax:
Mailing address:
  • Phone: 229-228-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number114281
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: