Provider Demographics
NPI:1043753791
Name:DELEE, DAWSON GARRETT
Entity Type:Individual
Prefix:
First Name:DAWSON
Middle Name:GARRETT
Last Name:DELEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39669-1097
Mailing Address - Country:US
Mailing Address - Phone:769-247-1240
Mailing Address - Fax:769-247-1241
Practice Address - Street 1:251 US HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:MS
Practice Address - Zip Code:39669-4619
Practice Address - Country:US
Practice Address - Phone:769-247-1240
Practice Address - Fax:769-247-1241
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021776183500000X
MST-15261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist