Provider Demographics
NPI:1700591252
Name:DAWSON, SHAMIKA R
Entity Type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:R
Last Name:DAWSON
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 1:4063 KINGS CROSSROADS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7390
Mailing Address - Country:US
Mailing Address - Phone:252-814-1003
Mailing Address - Fax:
Practice Address - Street 1:4063 KINGS CROSSROADS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7390
Practice Address - Country:US
Practice Address - Phone:252-814-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)