Healthcare Provider Details

I. General information

NPI: 1447454251
Provider Name (Legal Business Name): MARY HEBERT DAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 CAMPUS DR SUITE 200
ABINGDON VA
24210-9703
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-1186
  • Fax: 276-628-8507
Mailing address:
  • Phone: 423-302-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101247313
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: