Healthcare Provider Details

I. General information

NPI: 1952839847
Provider Name (Legal Business Name): ADDIE MAE DODSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE K201
LEXINGTON KY
40536-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD # MS 83
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6211
  • Fax: 859-257-0491
Mailing address:
  • Phone: 323-361-2101
  • Fax: 323-361-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54889
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179419
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number54889
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: