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General NPI Number Information
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NPI Number | 1225067135
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Entity Type | Individual
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Provider Name | DAWN D. IDOM MD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 1436 CHATTANOOGA AVE
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City | DALTON
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State | GA
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Zip | 30720-2637
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Country | US
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Telephone | 706-226-2142
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Fax | 706-226-1771
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Provider Business Mailing Address
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Address Line | PO BOX 6240
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City | DALTON
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State | GA
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Zip | 30722-6240
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Country | US
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Telephone | 706-226-2142
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Fax | 706-226-1771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 050891
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License Number State | GA
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