Active NPI
Holly McMahon Dawson, M.D.
- Pediatrics Physician
- Lagrange, GA
National Provider Identifier
1134416894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 84522
- Practice address
- 1514 Vernon Rd
Lagrange, GA 30240-4131 - Phone
- (706) 812-2369
- NPI assigned
- Jul 1, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 801-L | MS | |
| Pediatrics Physician | 208000000X | 84522 | GA | Primary |
| Pediatrics Physician | 208000000X | 40904 | SC | |
| Pediatrics Physician | 208000000X | 23324 | MS |
Addresses
Primary practice location
1514 Vernon Rd
Lagrange, GA 30240-4131
Mailing address
1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 812-2369
Other practice location 1
57 Cross Park Ct
Greenville, SC 29605-4264
Phone (864) 220-7270
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08431337 | Medicaid | MS | |
| 180328 | Medicaid | AL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | hdawson363217@directwellstar.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 801-L | MS | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients | |
| West Georgia Medical Center, Inc. | Past | Accepting new patients |
Locations
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1154317527
-
- Prosthetic/Orthotic Supplier
- Jackson, MS
- NPI 1235019530
-
- General Acute Care Hospital
- Lagrange, GA
- NPI 1821221144
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590105600000",
"number": "1134416894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1514 VERNON RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404131",
"telephone_number": "706-812-2369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 VERNON RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404131",
"telephone_number": "706-812-2369"
}
],
"practiceLocations": [
{
"address_1": "57 Cross Park Ct",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "SC",
"postal_code": "296054264",
"country_code": "US",
"telephone_number": "864-220-7270",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAWSON",
"first_name": "HOLLY",
"middle_name": "MCMAHON",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-01",
"last_updated": "2020-05-22",
"certification_date": "2020-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MS",
"license": "801-L",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "84522",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "40904",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MS",
"license": "23324",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08431337",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "180328",
"state": "AL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "hdawson363217@directwellstar.org",
"affiliation": "N",
"address_1": "1514 Vernon Rd",
"city": "LaGrange",
"state": "GA",
"country_code": "US",
"postal_code": "302404131",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Lagrange, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.