Healthcare Provider Details

I. General information

NPI: 1548515760
Provider Name (Legal Business Name): CAROLYN JOY DAWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2012
Last Update Date: 07/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 ROGERS RD
SCOTTS HILL TN
38374-5082
US

IV. Provider business mailing address

5110 ROGERS RD
SCOTTS HILL TN
38374-5082
US

V. Phone/Fax

Practice location:
  • Phone: 731-549-4215
  • Fax: 731-549-2509
Mailing address:
  • Phone: 731-549-4215
  • Fax: 731-549-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: