Provider Demographics
NPI:1083696389
Name:BODAMER, BRETT A (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:BODAMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-265-4766
Mailing Address - Fax:912-267-9857
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-265-4766
Practice Address - Fax:912-267-9857
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000668213ES0103X, 213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU32859Medicare UPIN
GA48SCCTFMedicare ID - Type UnspecifiedMEDICARE PROVIDER #