1689994360 NPI number — DAWN CELESTE HOWELL DAWN HOWELL

Table of content: DAWN CELESTE HOWELL DAWN HOWELL (NPI 1689994360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689994360 NPI number — DAWN CELESTE HOWELL DAWN HOWELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWELL
Provider First Name:
DAWN
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DAWN HOWELL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWELL
Provider Other First Name:
DAWN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DAWN HOWELL
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689994360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 SOUTH 1ST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JESUP
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-320-8773
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 HARMON AVE
Provider Second Line Business Practice Location Address:
WINN ARMY COMMUNITY HOSPITAL, FORT STEWART
Provider Business Practice Location Address City Name:
HINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-5674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-7001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1092289. , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105723800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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