MEDICARE: DAWN GERRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-05558	NC

General Provider Information

NPI Number	:	1407396112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN GERRELL

Provider Business Mailing Address
First Line	:	52 MADISON AVE.
Second Line	:
City	:	PRINCETON
State	:	NC
Zip	:	27569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 US 903 SOUTH
Second Line	:
City	:	MAURY
State	:	NC
Zip	:	28554
Country	:	US
Telephone Number	:	252-747-8103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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Directions to “ DAWN GERRELL ” Practice Location

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