Provider Demographics
NPI:1083491799
Name:GOOD SHEPHERD CLINIC OF DAWSON COUNTY, INC.
Entity Type:Organization
Organization Name:GOOD SHEPHERD CLINIC OF DAWSON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-805-4834
Mailing Address - Street 1:452 HIGHWAY 53 E UNIT 1009
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4153
Mailing Address - Country:US
Mailing Address - Phone:706-429-9914
Mailing Address - Fax:706-429-9921
Practice Address - Street 1:45 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6297
Practice Address - Country:US
Practice Address - Phone:706-429-9914
Practice Address - Fax:706-429-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health