=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760681548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDIOLOGY ASSOCIATES OF SPARTANBURG PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 07/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 E HENRY ST
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-583-7644
-----------------------------------------------------
Fax | 864-583-8118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 E HENRY ST
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-583-7644
-----------------------------------------------------
Fax | 864-583-8118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF AUDIOLOGY
-----------------------------------------------------
Name | DR. BENJAMIN WOFFORD DAWSEY JR.
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 864-583-7644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 2352
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 164
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------