Provider Demographics
NPI:1073862165
Name:DOGWOOD WELLNESS
Entity Type:Organization
Organization Name:DOGWOOD WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAEME
Authorized Official - Middle Name:M
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-507-7149
Mailing Address - Street 1:P O BOX 6
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0006
Mailing Address - Country:US
Mailing Address - Phone:828-507-7149
Mailing Address - Fax:828-586-5350
Practice Address - Street 1:163 HEMLOCK
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:NC
Practice Address - Zip Code:28725-0000
Practice Address - Country:US
Practice Address - Phone:828-507-7149
Practice Address - Fax:828-586-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700009176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136400Medicare UPIN