Provider Demographics
NPI:1376962092
Name:DODD, DEONNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEONNA
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5246 BRITTANY DR
Mailing Address - Street 2:ROOM 338
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9136
Mailing Address - Country:US
Mailing Address - Phone:225-757-4210
Mailing Address - Fax:
Practice Address - Street 1:5246 BRITTANY DR
Practice Address - Street 2:ROOM 338
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9136
Practice Address - Country:US
Practice Address - Phone:225-757-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL416952084P0800X
390200000X
LA3078222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty