Provider Demographics
NPI:1013391234
Name:DAWKINS, DEREK L SR
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:L
Last Name:DAWKINS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5664 PATHWAY CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-6100
Mailing Address - Country:US
Mailing Address - Phone:901-283-7447
Mailing Address - Fax:
Practice Address - Street 1:5664 PATHWAY CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-6100
Practice Address - Country:US
Practice Address - Phone:901-283-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN052141371347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle