Healthcare Provider Details

I. General information

NPI: 1306629100
Provider Name (Legal Business Name): ANDREW CLEVELAND DODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E MARION ST STE 250
SHELBY NC
28150-4982
US

IV. Provider business mailing address

PO BOX 1418
SHELBY NC
28151-1418
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-1882
  • Fax: 704-480-1832
Mailing address:
  • Phone: 704-480-1882
  • Fax: 704-480-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: