Provider Demographics
NPI:1376700989
Name:DAWSON, LEIA M (DO)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:M
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 JOHNSON FERRY RD STE 390
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9100
Mailing Address - Country:US
Mailing Address - Phone:470-250-1492
Mailing Address - Fax:470-235-7311
Practice Address - Street 1:1401 JOHNSON FERRY RD STE 390
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9100
Practice Address - Country:US
Practice Address - Phone:470-250-1492
Practice Address - Fax:470-235-7311
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109621BMedicaid
GA202I084884Medicare PIN