Provider Demographics
NPI:1114555083
Name:DAWSON, KAELAN (NP-BC)
Entity Type:Individual
Prefix:DR
First Name:KAELAN
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 FAIRFAX CIR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-4809
Mailing Address - Country:US
Mailing Address - Phone:706-988-9286
Mailing Address - Fax:
Practice Address - Street 1:775 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2211
Practice Address - Country:US
Practice Address - Phone:706-425-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2019046635363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2019046635Medicaid