Provider Demographics
NPI:1598833782
Name:DAWSON PHARMACY INC
Entity Type:Organization
Organization Name:DAWSON PHARMACY INC
Other - Org Name:DAWSON PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-995-2131
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-0430
Mailing Address - Country:US
Mailing Address - Phone:229-995-2131
Mailing Address - Fax:
Practice Address - Street 1:101 E LEE ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1485
Practice Address - Country:US
Practice Address - Phone:229-995-2131
Practice Address - Fax:229-995-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0053733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012201OtherPK
GA00025803AMedicaid
GA00025803AMedicaid