Healthcare Provider Details

I. General information

NPI: 1639597610
Provider Name (Legal Business Name): IAN B DODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

1238 N. BROAD STREET APARTMENT A
NEW ORLEANS LA
70119
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8865
  • Fax:
Mailing address:
  • Phone: 256-541-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number078018
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD24028
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: