Provider Demographics
NPI:1912017468
Name:SUMRALL, DAWN M (MD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:MD
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 1348
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-1348
Mailing Address - Country:US
Mailing Address - Phone:601-684-9116
Mailing Address - Fax:601-684-9126
Practice Address - Street 1:205 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2705
Practice Address - Country:US
Practice Address - Phone:601-684-9116
Practice Address - Fax:601-684-9126
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115271Medicaid
MSCJ3236OtherRAILROAD MEDICARE
MSE72686Medicare UPIN
MSC02645Medicare PIN