Provider Demographics
NPI:1740519966
Name:DAWSON, G EDWIN (MS)
Entity type:Individual
Prefix:MR
First Name:G
Middle Name:EDWIN
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-8639
Mailing Address - Country:US
Mailing Address - Phone:336-247-1607
Mailing Address - Fax:
Practice Address - Street 1:112 CHOCTAW DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-8639
Practice Address - Country:US
Practice Address - Phone:336-247-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical