Healthcare Provider Details

I. General information

NPI: 1962488510
Provider Name (Legal Business Name): DAVID D DODD OPA-C, CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WESTWIND DR
BALL GROUND GA
30107-7722
US

IV. Provider business mailing address

234 WESTWIND DR
BALL GROUND GA
30107-7722
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-1233
  • Fax: 770-205-0483
Mailing address:
  • Phone: 770-205-1233
  • Fax: 770-205-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: