Healthcare Provider Details

I. General information

NPI: 1518930296
Provider Name (Legal Business Name): DAWN R CHITWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 UNDERPASS DR
ONEIDA TN
37841-5885
US

IV. Provider business mailing address

725 PINE GROVE RD
WINFIELD TN
37892-3409
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-7800
  • Fax: 423-569-7801
Mailing address:
  • Phone: 423-569-3766
  • Fax: 423-569-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number24301
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: