Healthcare Provider Details

I. General information

NPI: 1134115967
Provider Name (Legal Business Name): MICHELLE SHELNUTT DODDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVA MICHELLE SHELNUTT DODDER M.D.

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 MORRIS RD SUITE 310
ALPHARETTA GA
30005-4419
US

IV. Provider business mailing address

5780 PEACHTREE DUNWOODY ROAD SUITE 300
ATLANTA GA
30342-1513
US

V. Phone/Fax

Practice location:
  • Phone: 770-752-0824
  • Fax: 770-752-0845
Mailing address:
  • Phone: 404-303-1224
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number040784
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number040784
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: