=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528173432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY CARL DINDOFFER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 07/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1107 MEMORIAL DR SUITE 301
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-8662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-271-0076
-----------------------------------------------------
Fax | 706-271-0086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 MEMORIAL DR SUITE 301
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-8662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-271-0076
-----------------------------------------------------
Fax | 706-271-0086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 042812
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------