Healthcare Provider Details

I. General information

NPI: 1396705034
Provider Name (Legal Business Name): HEATHER ROSE DAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8761 DORCHESTER RD STE 100
NORTH CHARLESTON SC
29420-7320
US

IV. Provider business mailing address

PO BOX 13955
CHARLESTON SC
29422-3955
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-3323
  • Fax: 843-767-4252
Mailing address:
  • Phone: 843-767-3323
  • Fax: 843-767-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17172
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17172
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: