Provider Demographics
NPI:1083148084
Name:SODERSTROM, DRESDEN MELTON (MD)
Entity Type:Individual
Prefix:
First Name:DRESDEN
Middle Name:MELTON
Last Name:SODERSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DRESDEN
Other - Middle Name:MIRANDA
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6783
Mailing Address - Country:US
Mailing Address - Phone:229-785-2400
Mailing Address - Fax:
Practice Address - Street 1:4 LIVE OAK CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6783
Practice Address - Country:US
Practice Address - Phone:229-785-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA96693208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program