Basic Information
| Provider Information | |||||||||
| NPI: | 1306195565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | MAGGIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2065 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393022065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017034282 | ||||||||
| FaxNumber: | 6017039283 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 HIGHWAY 13 S | ||||||||
| Address2: | |||||||||
| City: | MORTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391173353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017328612 | ||||||||
| FaxNumber: | 6017321957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2012 | ||||||||
| LastUpdateDate: | 11/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R746447 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02080388 | 05 | MS | MEDICAID |