Provider Demographics
NPI:1134153711
Name:DAWSON, MICHAEL J JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DAWSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S GRANGE AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0401
Mailing Address - Country:US
Mailing Address - Phone:605-328-8500
Mailing Address - Fax:605-328-8501
Practice Address - Street 1:4 LIVE OAK CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6783
Practice Address - Country:US
Practice Address - Phone:229-785-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034811207RG0100X
SD9640207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA034811OtherSTATE LICENSE NUMBER
GA034811OtherSTATE LICENSE NUMBER
GAE96512Medicare UPIN