Healthcare Provider Details

I. General information

NPI: 1053183210
Provider Name (Legal Business Name): DISHAWN EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 US HIGHWAY 301
GARYSBURG NC
27831-9611
US

IV. Provider business mailing address

489 US HIGHWAY 301
GARYSBURG NC
27831-9611
US

V. Phone/Fax

Practice location:
  • Phone: 252-326-6732
  • Fax:
Mailing address:
  • Phone: 252-326-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: