Healthcare Provider Details

I. General information

NPI: 1497899892
Provider Name (Legal Business Name): DAWN POLLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 COMMONWEALTH DR SUITE C
GREENVILLE SC
29615-4869
US

IV. Provider business mailing address

274 COMMONWEALTH DR SUITE C
GREENVILLE SC
29615-4869
US

V. Phone/Fax

Practice location:
  • Phone: 864-551-2422
  • Fax: 864-551-2424
Mailing address:
  • Phone: 864-551-2422
  • Fax: 864-551-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28748
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: