Provider Demographics
NPI:1093855934
Name:DAWSON, ANGELA KATHLEEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KATHLEEN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:COASTAL CHILD DR ANGELA DAWSON
Mailing Address - Street 2:1331 OCEAN BLVD SUITE 103
Mailing Address - City:ST. SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:
Practice Address - Street 1:COASTAL CHILD
Practice Address - Street 2:1331 OCEAN BLVD SUITE 103
Practice Address - City:ST. SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522
Practice Address - Country:US
Practice Address - Phone:706-509-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0408952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000751638FMedicaid
GA202I264531Medicare UPIN