Provider Demographics
NPI:1548022973
Name:DOTSON, AIRRICK DEVONTE
Entity type:Individual
Prefix:
First Name:AIRRICK
Middle Name:DEVONTE
Last Name:DOTSON
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 1:3793 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5705
Mailing Address - Country:US
Mailing Address - Phone:216-232-5302
Mailing Address - Fax:
Practice Address - Street 1:3793 GREEN RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5705
Practice Address - Country:US
Practice Address - Phone:216-232-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator