MEDICARE: MRS. MARY N DOTSON NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	RN085083 NP	GA

General Provider Information

NPI Number	:	1508977240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY N DOTSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	498 DOTSON RD STE 1
Second Line	:
City	:	STATHAM
State	:	GA
Zip	:	30666-1902
Country	:	US
Telephone Number	:	770-725-5174
Fax Number	:	706-548-0555

Provider Business Practice Location Address
First Line	:	21 JEFFERSON PL
Second Line	:	SUITE 1
City	:	ATHENS
State	:	GA
Zip	:	30601-1761
Country	:	US
Telephone Number	:	706-548-0058
Fax Number	:	706-548-0555

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/06/2026

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