Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN117801 | GA |
NPI | 1003104670 |
---|---|
Provider Name | John Stephen Dodd |
First Address | Valdosta, GA 31602-1735 |
Second Address | Valdosta, GA 31602-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 18/07/2011 |