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General NPI Number Information
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NPI Number | 1912787276
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Entity Type | Organization
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Legal Business Name | NOWAITLIST LLC
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 4323 FM 1878
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City | NACOGDOCHES
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State | TX
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Zip | 75961-0318
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Country | US
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Telephone | 512-623-0641
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Fax |
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Provider Business Mailing Address
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Address Line | 4323 FM 1878
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City | NACOGDOCHES
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State | TX
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Zip | 75961-0318
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Country | US
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Telephone | 512-623-0641
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUKE DODSON
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Credential |
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Telephone | 512-623-0641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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