Provider Demographics
NPI:1417548553
Name:DAWES, MICHAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:DAWES
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 1:1600 WESTERN BLVD
Mailing Address - Street 2:SUITE #31
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-0602
Mailing Address - Country:US
Mailing Address - Phone:252-508-1229
Mailing Address - Fax:
Practice Address - Street 1:1600 WESTERN BLVD., RIVERSIDE PLAZA #31
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2788
Practice Address - Country:US
Practice Address - Phone:252-641-6885
Practice Address - Fax:252-641-6889
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5808251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health