Provider Demographics
NPI:1518436294
Name:CARR, DYSHON MARLON
Entity Type:Individual
Prefix:
First Name:DYSHON
Middle Name:MARLON
Last Name:CARR
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 1:619 S KERR AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8423
Mailing Address - Country:US
Mailing Address - Phone:919-802-3696
Mailing Address - Fax:
Practice Address - Street 1:619 S KERR AVE APT 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8423
Practice Address - Country:US
Practice Address - Phone:919-802-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty