Active NPI
Ida Johnson Dawson, P.A.
- Physician Assistant
- Raleigh, NC
National Provider Identifier
1194862722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 101111
- Practice address
- 10 Sunnybrook Rd
Raleigh, NC 27610-1808 - Phone
- (919) 250-4629
- Fax
- (919) 250-4517
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 101111 | NC | Primary |
Addresses
Primary practice location
10 Sunnybrook Rd
Raleigh, NC 27610-1808
Mailing address
204 Longview Lake Dr
Raleigh, NC 27610-1876
Phone (919) 255-6752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101111 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194862722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 LONGVIEW LAKE DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276101876",
"telephone_number": "919-255-6752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 SUNNYBROOK RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276101808",
"telephone_number": "919-250-4629",
"fax_number": "919-250-4517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAWSON",
"first_name": "IDA",
"middle_name": "JOHNSON",
"name_prefix": "Ms.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "101111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.