Individual
DAWN B MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12205 COUNTY LINE RD, SUITE B, MADISON, AL 35758-7719
(256) 325-4365
(256) 461-0393
Mailing address
PO BOX 617, MADISON, AL 35758-0617
(256) 325-4365
(256) 461-0393
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15990
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051506404
BC/BS
AL
Enumeration date
08/03/2006
Last updated
02/24/2011
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