Provider Demographics
NPI:1053183210
Name:EDWARDS, DISHAWN
Entity type:Individual
Prefix:
First Name:DISHAWN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:GARYSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27831-9611
Mailing Address - Country:US
Mailing Address - Phone:252-326-6732
Mailing Address - Fax:
Practice Address - Street 1:489 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:GARYSBURG
Practice Address - State:NC
Practice Address - Zip Code:27831-9611
Practice Address - Country:US
Practice Address - Phone:252-326-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NC224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No374U00000XNursing Service Related ProvidersHome Health Aide