Provider Demographics
NPI:1942853726
Name:DYSON, JOHN EUGENE
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EUGENE
Last Name:DYSON
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:PO BOX 680427
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0008
Mailing Address - Country:US
Mailing Address - Phone:704-641-4515
Mailing Address - Fax:866-586-7685
Practice Address - Street 1:100 7TH ST SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2410
Practice Address - Country:US
Practice Address - Phone:828-632-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional