Provider Demographics
NPI:1235398165
Name:DOGWOOD WELLNESS, PA
Entity Type:Organization
Organization Name:DOGWOOD WELLNESS, PA
Other - Org Name:BACKACRE MEDICAL, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAEME
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-586-6262
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28725-1125
Mailing Address - Country:US
Mailing Address - Phone:828-586-6262
Mailing Address - Fax:828-586-8008
Practice Address - Street 1:377 MACKTOWN RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-7627
Practice Address - Country:US
Practice Address - Phone:828-586-6262
Practice Address - Fax:828-412-4294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7274023OtherCIGNA
NC5907766Medicaid
2071530Medicare PIN