Healthcare Provider Details

I. General information

NPI: 1851510820
Provider Name (Legal Business Name): DODD SURGICAL ASSISITING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
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: 770-985-4257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DAVID DODD
Title or Position: OWNER
Credential:
Phone: 770-985-4257