Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 54208 | TN |
N | 208000000X | Pediatrician | 84033 | SC |
Y | 2080P0216X | Pediatric Rheumatologist | 84033 | SC |
NPI | 1083059232 |
---|---|
Provider Name | Jodi Dingle |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
840335 | (05) | SC |