Individual
DWAYNE BRIAN MARYOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1850 W ARLINGTON BLVD, GREENVILLE, NC 27834-5704
(252) 413-6202
(252) 758-8333
Mailing address
1840 W ARLINGTON BLVD, GREENVILLE, NC 27834-5704
(252) 413-6202
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01043
NC
363AM0700X
Medical Physician Assistant
004628-1
NY
363AM0700X
Medical Physician Assistant
MA001621L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8102826
—
NC
Enumeration date
01/21/2006
Last updated
05/20/2015
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