Provider Demographics
NPI:1710115407
Name:MCDOUGALD, DAWN MICHELE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MICHELE
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 DARTFORD WAY
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1690
Mailing Address - Country:US
Mailing Address - Phone:678-656-7996
Mailing Address - Fax:
Practice Address - Street 1:1795 DARTFORD WAY
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-1690
Practice Address - Country:US
Practice Address - Phone:678-656-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered