Provider Demographics
NPI:1174969471
Name:DAWSON, MORGAN KRISTINE (AA)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:KRISTINE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:714 PEACHTREE HILLS CIR NE
Mailing Address - Street 2:APT 714
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4246
Mailing Address - Country:US
Mailing Address - Phone:478-951-9076
Mailing Address - Fax:
Practice Address - Street 1:1740 HUDSON BRIDGE RD
Practice Address - Street 2:SUITE 1218
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6331
Practice Address - Country:US
Practice Address - Phone:678-604-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6761367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7504Medicare Oscar/Certification