MEDICARE: MOLLIE DODSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	37380	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760486112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE DODSON MD

Provider Business Mailing Address
First Line	:	705 HOWELL ST
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1008
Country	:	US
Telephone Number	:	931-739-0048
Fax Number	:	931-739-0047

Provider Business Practice Location Address
First Line	:	705 HOWELL ST
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1008
Country	:	US
Telephone Number	:	931-739-0048
Fax Number	:	931-739-0047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/23/2014

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Directions to “ MOLLIE DODSON MD” Practice Location

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