Provider Demographics
NPI:1932229184
Name:MARLEY, DWAYNE C (CPO)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:C
Last Name:MARLEY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403C YANCEYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6931
Mailing Address - Country:US
Mailing Address - Phone:336-272-5155
Mailing Address - Fax:336-275-8530
Practice Address - Street 1:1403C YANCEYVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6931
Practice Address - Country:US
Practice Address - Phone:336-272-5155
Practice Address - Fax:336-275-8530
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795088Medicaid