Provider Demographics
NPI:1710988472
Name:MACMILLAN, DAWN HOSTETLER (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:HOSTETLER
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-0052
Mailing Address - Country:US
Mailing Address - Phone:912-748-9494
Mailing Address - Fax:912-748-9495
Practice Address - Street 1:410 US HIGHWAY 80 SW
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2541
Practice Address - Country:US
Practice Address - Phone:912-748-9494
Practice Address - Fax:912-748-9495
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003683231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA861992492AMedicaid
GAQ37332Medicare UPIN
GA64BCBNCMedicare ID - Type Unspecified
GA64BCBNCMedicare ID - Type Unspecified