Provider Demographics
NPI:1811141849
Name:DAWSON STREET FAMILY PRACTICE P.A.
Entity type:Organization
Organization Name:DAWSON STREET FAMILY PRACTICE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-667-0471
Mailing Address - Street 1:608 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5712
Mailing Address - Country:US
Mailing Address - Phone:910-667-0471
Mailing Address - Fax:910-667-0475
Practice Address - Street 1:608 DAWSON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5712
Practice Address - Country:US
Practice Address - Phone:910-667-0471
Practice Address - Fax:910-667-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC153430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty