Provider Demographics
NPI:1659086486
Name:DODSON, WILLIAM MURRY (CNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MURRY
Last Name:DODSON
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:MURRY
Other - Last Name:KOSCINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:10751 LIMU WAY
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-4348
Mailing Address - Country:US
Mailing Address - Phone:228-380-1931
Mailing Address - Fax:
Practice Address - Street 1:10751 LIMU WAY
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-4348
Practice Address - Country:US
Practice Address - Phone:228-380-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014242811376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide