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NPI Code Detail

MEDICARE: DR. DERRICK LAMONYE DAWSON JR.

MEDICARE: DR. DERRICK LAMONYE DAWSON JR.
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
1111N00000XChiropractorCHIR009146GA
2111N00000XChiropractorCH 10727FL
3133V00000XRegistered DietitianLD004157GA

General Provider Information

NPI Number : 1861815169
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DERRICK LAMONYE DAWSON JR.
Provider Business Mailing Address
First Line : 4571 VALLEY PKWY SE APT J
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4942
Country : US
Telephone Number : 229-563-0739
Fax Number :
Provider Business Practice Location Address
First Line : 4571 VALLEY PKWY SE APT J
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4942
Country : US
Telephone Number : 229-563-0739
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2014
Last Update Date : 01/23/2014

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