Individual provider Active NPI

Holly McMahon Dawson, M.D.

  • Pediatrics Physician
  • Lagrange, GA
National Provider Identifier
1134416894
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
84522 Issued in GA
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

Updated by the provider on May 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
08431337MedicaidMS
180328MedicaidAL

Electronic endpoints 1

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140825002019 MS Practitioner - Pediatric Medicine 0749408227 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
801-LMSMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jul 14, 2014 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jul 14, 2014 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.

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

Verify at the official NPI Registry.