Provider Demographics
NPI:1659448744
Name:DAWSON, DAMON
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
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 1:3578 S FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1756
Mailing Address - Country:US
Mailing Address - Phone:404-426-4406
Mailing Address - Fax:404-492-7174
Practice Address - Street 1:330 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:404-294-0774
Practice Address - Fax:404-294-0775
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional