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General NPI Number Information
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NPI Number | 1417548553
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Entity Type | Individual
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Provider Name | MR. MICHAEL DAWES
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Gender | Male
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1600 WESTERN BLVD., RIVERSIDE PLAZA #31
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City | TARBORO
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State | NC
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Zip | 27886-2788
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Country | US
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Telephone | 252-641-6885
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Fax | 252-641-6889
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Provider Business Mailing Address
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Address Line | 1600 WESTERN BLVD SUITE #31
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City | TARBORO
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State | NC
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Zip | 27886-0602
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Country | US
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Telephone | 252-508-1229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC5808
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License Number State | NC
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