Provider Demographics
NPI:1407396112
Name:GERRELL, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:HINES
Other - Last Name:GERRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:52 MADISON AVE.
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2821 US 903 SOUTH
Practice Address - Street 2:
Practice Address - City:MAURY
Practice Address - State:NC
Practice Address - Zip Code:28554
Practice Address - Country:US
Practice Address - Phone:252-747-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant