Provider Demographics
NPI:1972052116
Name:DAWKINS, ANTAMARIE
Entity Type:Individual
Prefix:
First Name:ANTAMARIE
Middle Name:
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3444
Mailing Address - Country:US
Mailing Address - Phone:843-506-1893
Mailing Address - Fax:843-506-8154
Practice Address - Street 1:106 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3444
Practice Address - Country:US
Practice Address - Phone:843-506-1893
Practice Address - Fax:843-506-8154
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0235374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1417Medicaid