Healthcare Provider Details

I. General information

NPI: 1437440724
Provider Name (Legal Business Name): DAWN LAIN BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 GREEN VALLEY RD STE 104
GREENSBORO NC
27408-7043
US

IV. Provider business mailing address

706 GREEN VALLEY RD STE 104
GREENSBORO NC
27408-7043
US

V. Phone/Fax

Practice location:
  • Phone: 336-387-2500
  • Fax: 844-751-9263
Mailing address:
  • Phone: 336-387-2500
  • Fax: 844-751-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number19157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: