Provider Demographics
NPI:1831944040
Name:DAWSON, JANET ELIZABETH
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELIZABETH
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 CAMP VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1712
Mailing Address - Country:US
Mailing Address - Phone:404-551-9789
Mailing Address - Fax:
Practice Address - Street 1:7020 CAMP VALLEY RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1712
Practice Address - Country:US
Practice Address - Phone:404-551-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician