Provider Demographics
NPI:1285045070
Name:DAWSON, VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3948 3RD ST S # 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-543-0161
Mailing Address - Fax:
Practice Address - Street 1:1538 THE GREENS WAY STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-1400
Practice Address - Country:US
Practice Address - Phone:904-543-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68962084P0800X
FLME1484722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty