Healthcare Provider Details

I. General information

NPI: 1568623965
Provider Name (Legal Business Name): MRS. TANESHA K DAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PONDELLA DR
ENTERPRISE AL
36330-4508
US

IV. Provider business mailing address

301 ANDREWS AVE
FORT RUCKER AL
36362
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-7894
  • Fax: 334-255-7490
Mailing address:
  • Phone: 334-255-7894
  • Fax: 334-255-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: