Provider Demographics
NPI:1407412836
Name:DAWSON, RICHARD LEE
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 AUSTIN COMMON WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019
Mailing Address - Country:US
Mailing Address - Phone:678-923-0903
Mailing Address - Fax:
Practice Address - Street 1:4757 STONE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4600
Practice Address - Country:US
Practice Address - Phone:705-452-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003214200AMedicaid