Basic Information
Provider Information
NPI: 1720324403
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOSS
FirstName: CATHERINE
MiddleName: EWING
NamePrefix: MRS.
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2041 VALLEYGATE DR
Address2:  
City: FAYETTEVILLE
State: NC
PostalCode: 283043745
CountryCode: US
TelephoneNumber: 9103235203
FaxNumber: 9103233650
Practice Location
Address1: 2041 VALLEYGATE DR
Address2:  
City: FAYETTEVILLE
State: NC
PostalCode: 283043745
CountryCode: US
TelephoneNumber: 9103235203
FaxNumber: 9103233650
Other Information
ProviderEnumerationDate: 12/27/2012
LastUpdateDate: 12/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X001003983NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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