Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 029629 | GA |
NPI | 1093731713 |
---|---|
Provider Name | Thomas Dodson |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1170419 | UNITED HEALTHCARE (01) | GA |
273472 | BLUE CROSS BLUE SHEILD (01) | GA |
537314 | US HEALTHCARE (01) | GA |
B98713001 | (02) | GA |
Y 19980601 | PHCS (01) | GA |