Individual
DAWN D. IDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1436 CHATTANOOGA AVE, DALTON, GA 30720-2637
(706) 226-2142
(706) 226-1771
Mailing address
PO BOX 6240, DALTON, GA 30722-6240
(706) 226-2142
(706) 226-1771
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
050891
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00932324A
—
GA
01
—
050084341
RAILROAD MEDICARE
GA
01
—
331239
WELLCARE
GA
01
—
883067
BLUE CROSS
GA
01
—
CM 5659
RAILROAD MEDICARE GRP
GA
01
—
GRP 332
MEDICARE GRP NUMBER
GA
Enumeration date
07/02/2006
Last updated
01/23/2017
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