Provider Demographics
NPI:1750435749
Name:DAWSON PEDIATRICS,PC
Entity type:Organization
Organization Name:DAWSON PEDIATRICS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HONORIO
Authorized Official - Middle Name:ROWELL
Authorized Official - Last Name:BULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:706-216-2771
Mailing Address - Street 1:300 DAWSON COMMONS CIR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6268
Mailing Address - Country:US
Mailing Address - Phone:706-216-2771
Mailing Address - Fax:706-216-2944
Practice Address - Street 1:300 DAWSON COMMONS CIR
Practice Address - Street 2:SUITE 320
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6268
Practice Address - Country:US
Practice Address - Phone:706-216-2771
Practice Address - Fax:706-216-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA728415762AMedicaid