Most Relevant Information
Provider Data
| NPI Number: | 1003019464 |
| Provider Name: | ISSAC DAWON EARLS |
| Entity Type: | Individual |
| Taxonomy Code: | 320900000X |
| Specialty: | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/06/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
4502 MAGIN MEADOW DR
AUSTIN
TX
787445248
Practice Location Phone/Fax
| Phone: | 5129477875 |
| Fax: |
Provider Mailing Location
4502 MAGIN MEADOW DR
AUSTIN
TX
787445248
Provider Mailing Phone/Fax
| Phone: | 5129477875 |
| Fax: |