Provider Demographics
NPI:1538961438
Name:DAWSON, JOHNNY EARL
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:EARL
Last Name:DAWSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 CHATARAN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-7900
Mailing Address - Country:US
Mailing Address - Phone:443-280-5801
Mailing Address - Fax:443-280-5801
Practice Address - Street 1:6823 CHATARAN DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-7900
Practice Address - Country:US
Practice Address - Phone:443-280-5801
Practice Address - Fax:443-280-5801
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236764163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management