Provider Demographics
NPI:1023063567
Name:COMMISSIONER OF ROADS AND REVENUE DAWSON COUNTY
Entity type:Organization
Organization Name:COMMISSIONER OF ROADS AND REVENUE DAWSON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-344-3501
Mailing Address - Street 1:393 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4315
Mailing Address - Country:US
Mailing Address - Phone:706-344-3501
Mailing Address - Fax:706-344-3504
Practice Address - Street 1:393 MEMORY LN
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-4315
Practice Address - Country:US
Practice Address - Phone:706-344-3501
Practice Address - Fax:706-344-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042-013416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000313893AMedicaid
85011759AAOtherMEDICARE PROVIDER ID #
GA1023063567Medicare PIN
GA85011759AAMedicare ID - Type Unspecified