Provider Demographics
NPI:1104456508
Name:DODSON, ERIN HALEY (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:HALEY
Last Name:DODSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:HALEY
Other - Last Name:DIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 117287
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7287
Mailing Address - Country:US
Mailing Address - Phone:866-266-0555
Mailing Address - Fax:866-266-4999
Practice Address - Street 1:300 ASHVILLE AVE STE 310
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8682
Practice Address - Country:US
Practice Address - Phone:919-233-8585
Practice Address - Fax:919-233-8566
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-10420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program