Provider Demographics
NPI:1952632259
Name:DRAWDY, JONATHAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:DRAWDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SCREVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3464
Mailing Address - Country:US
Mailing Address - Phone:912-285-0062
Mailing Address - Fax:912-285-5006
Practice Address - Street 1:504 SCREVEN AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3464
Practice Address - Country:US
Practice Address - Phone:912-285-0062
Practice Address - Fax:912-285-5006
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist