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General NPI Number Information
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NPI Number | 1639168339
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Entity Type | Individual
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Provider Name | TERRY L. DODGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK DR
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City | CHESTER
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State | SC
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Zip | 29706-9769
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Country | US
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Telephone | 803-581-3151
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Fax | 803-385-3183
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Provider Business Mailing Address
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Address Line | 1 MEDICAL PARK DR
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City | CHESTER
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State | SC
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Zip | 29706-9769
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Country | US
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Telephone | 803-581-3151
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Fax | 803-385-3183
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 6992
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License Number State | SC
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