Provider Demographics
NPI:1801548615
Name:DABNEY PROFESSIONAL GROUP, LLC.
Entity type:Organization
Organization Name:DABNEY PROFESSIONAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:901-338-8577
Mailing Address - Street 1:2475 MONTCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5076
Mailing Address - Country:US
Mailing Address - Phone:901-338-8577
Mailing Address - Fax:
Practice Address - Street 1:2475 MONTCLAIR LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5076
Practice Address - Country:US
Practice Address - Phone:901-338-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty