Basic Information
| Provider Information | |||||||||
| NPI: | 1215915277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEY | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | WADDELL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3351 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312102587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782016500 | ||||||||
| FaxNumber: | 4787570876 | ||||||||
| Practice Location | |||||||||
| Address1: | 3351 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312102587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782016500 | ||||||||
| FaxNumber: | 4787570876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN107136 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.