Provider Demographics
NPI:1104388909
Name:DOTTERY, VERNELL
Entity Type:Individual
Prefix:
First Name:VERNELL
Middle Name:
Last Name:DOTTERY
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 1:8094 N HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-9414
Mailing Address - Country:US
Mailing Address - Phone:843-442-5263
Mailing Address - Fax:
Practice Address - Street 1:12488 OLD NUMBER SIX HWY
Practice Address - Street 2:
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-9167
Practice Address - Country:US
Practice Address - Phone:843-442-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility