Provider Demographics
NPI:1700817277
Name:DAWSON, CHARLES W JR (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:DAWSON
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:300 CHURCH STREET
Mailing Address - Street 2:SHA ER
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1181
Mailing Address - Country:US
Mailing Address - Phone:865-213-8524
Mailing Address - Fax:
Practice Address - Street 1:705 VETERANS MEM. DRIVE
Practice Address - Street 2:
Practice Address - City:TELLICO
Practice Address - State:TN
Practice Address - Zip Code:37385-1402
Practice Address - Country:US
Practice Address - Phone:423-506-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3666310Medicare ID - Type UnspecifiedSWEETWATER HOSPITAL ASSOC
R96294Medicare UPIN