Provider Demographics
NPI:1336636588
Name:COLVIN, DWIGHT
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:
Last Name:COLVIN
Suffix:
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 1:12339 WAKE UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4512
Mailing Address - Country:US
Mailing Address - Phone:919-263-9293
Mailing Address - Fax:
Practice Address - Street 1:5198 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1331
Practice Address - Country:US
Practice Address - Phone:216-378-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator