Healthcare Provider Details

I. General information

NPI: 1659295236
Provider Name (Legal Business Name): DODGE IMMEDIATE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 PLAZA AVE
EASTMAN GA
31023-6757
US

IV. Provider business mailing address

829 PLAZA AVE
EASTMAN GA
31023-6757
US

V. Phone/Fax

Practice location:
  • Phone: 478-448-8272
  • Fax: 478-448-8273
Mailing address:
  • Phone: 478-448-8272
  • Fax: 478-448-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN HAMRICK
Title or Position: CFO
Credential:
Phone: 478-448-4050