MEDICARE: MR. G EDWIN DAWSON M.S.

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	103TC0700X	Clinical Psychologist	0452	NC

General Provider Information

NPI Number	:	1740519966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. G EDWIN DAWSON M.S.

Provider Business Mailing Address
First Line	:	112 CHOCTAW DR
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-8639
Country	:	US
Telephone Number	:	336-247-1607
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 CHOCTAW DR
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-8639
Country	:	US
Telephone Number	:	336-247-1607
Fax Number	:

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

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	12/17/2009

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