Provider Demographics
NPI:1447711080
Name:DAWSON, LAJHONDA BONSHA
Entity type:Individual
Prefix:MS
First Name:LAJHONDA
Middle Name:BONSHA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 SE AURORA WAY
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-6704
Mailing Address - Country:US
Mailing Address - Phone:772-324-1790
Mailing Address - Fax:
Practice Address - Street 1:8606 SE AURORA WAY
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-6704
Practice Address - Country:US
Practice Address - Phone:772-324-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6859776490Medicaid