MEDICARE: MR. RICHARD LEE DAWSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407412836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD LEE DAWSON

Provider Business Mailing Address
First Line	:	2158 AUSTIN COMMON WAY
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019
Country	:	US
Telephone Number	:	678-923-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	4757 STONE MOUNTAIN HWY
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-4600
Country	:	US
Telephone Number	:	705-452-2954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/10/2019

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