Provider Demographics
NPI:1740531516
Name:GLISSON, DAWN BECK (NP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:BECK
Last Name:GLISSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:SINGLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:907 18TH ST E STE 400
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3684
Mailing Address - Country:US
Mailing Address - Phone:229-353-3422
Mailing Address - Fax:229-353-6060
Practice Address - Street 1:901 18TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3648
Practice Address - Country:US
Practice Address - Phone:229-382-7120
Practice Address - Fax:229-391-3332
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner