Simala Young, Dawn Marie Gavagan

Simala Young, Dawn Marie Gavagan is an individual health care provider with primary practice located at 501 Olde Waterford Way , Leland NC 28451-4117. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Simala Young, Dawn Marie Gavagan can be contacted via phone (910) 408-1130.

Contact Information

Primary practice address
501 Olde Waterford Way Leland NC 28451-4117
Fax: (910) 408-1135
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 02001458 Indiana
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2022-02976 North Carolina

Profile Details

NPI number 1750368726
LBN Legal business name Simala Young, Dawn Marie Gavagan
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Mar 15th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750368726 NPPES
Indiana Other P01609365 RR PTAN (MIAMI)
Indiana MEDICAID 100365980 RR PTAN (MIAMI)
Indiana Other 000000984586 RR PTAN (MIAMI)

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