Provider Demographics
NPI:1578195509
Name:DAWSON, KEYANNA BRESHA
Entity Type:Individual
Prefix:
First Name:KEYANNA
Middle Name:BRESHA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N WILKINSON ST APT C26
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2872
Mailing Address - Country:US
Mailing Address - Phone:229-313-3840
Mailing Address - Fax:
Practice Address - Street 1:501 N WILKINSON ST APT C26
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2872
Practice Address - Country:US
Practice Address - Phone:229-313-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer