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General NPI Number Information
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NPI Number | 1083491799
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD CLINIC OF DAWSON COUNTY, INC.
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 45 MEDICAL CENTER DR
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6297
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Country | US
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Telephone | 706-429-9914
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Fax | 706-429-9921
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Provider Business Mailing Address
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Address Line | 452 HIGHWAY 53 E UNIT 1009
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City | DAWSONVILLE
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State | GA
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Zip | 30534-4153
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Country | US
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Telephone | 706-429-9914
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Fax | 706-429-9921
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID K MOORE
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Credential | MD
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Telephone | 404-805-4834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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