Provider Demographics
NPI:1083706071
Name:SOLODAR, SEYMOUR
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:
Last Name:SOLODAR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SEYMOUR
Other - Middle Name:
Other - Last Name:SOLODAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4015 SOUTH COBB DR., STE. 10
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-874-6100
Mailing Address - Fax:770-874-6104
Practice Address - Street 1:4015 SOUTH COBB DR., STE. 10
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-874-6100
Practice Address - Fax:770-874-6104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30856Medicare UPIN