1841648466 NPI number — MRS. ANDRINA MICHELL DAWSON R.DH.

Table of content: MRS. ANDRINA MICHELL DAWSON R.DH. (NPI 1841648466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841648466 NPI number — MRS. ANDRINA MICHELL DAWSON R.DH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWSON
Provider First Name:
ANDRINA
Provider Middle Name:
MICHELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.DH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHANNON
Provider Other First Name:
ANDRINA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.H.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841648466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7101 HOFF ST
Provider Second Line Business Mailing Address:
BLDG 9240
Provider Business Mailing Address City Name:
FORT BENNING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31905-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-544-3103
Provider Business Mailing Address Fax Number:
706-544-1933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7101 HOFF ST
Provider Second Line Business Practice Location Address:
BLDG 9240
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905-5645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-544-3103
Provider Business Practice Location Address Fax Number:
706-544-1933
Provider Enumeration Date:
05/25/2016

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: 124Q00000X , with the licence number:  011980 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 124Q00000X , with the licence number: 19428 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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