Provider Demographics
NPI:1326185786
Name:RAWLS, MARK S
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:RAWLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-6741
Mailing Address - Country:US
Mailing Address - Phone:252-794-5530
Mailing Address - Fax:252-794-6599
Practice Address - Street 1:208 E WATER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6741
Practice Address - Country:US
Practice Address - Phone:252-794-5530
Practice Address - Fax:252-794-6599
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3606374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide