Provider Demographics
NPI:1184070138
Name:AMMONS, DWAYNE MCPHERSON
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:MCPHERSON
Last Name:AMMONS
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 1:5599 ROBMONT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2665
Mailing Address - Country:US
Mailing Address - Phone:910-527-8800
Mailing Address - Fax:
Practice Address - Street 1:5599 ROBMONT DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2665
Practice Address - Country:US
Practice Address - Phone:910-527-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional