Provider Demographics
NPI:1790348928
Name:DODSON, SHARELL (MSW)
Entity Type:Individual
Prefix:
First Name:SHARELL
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 NOTTINGHAM WAY APT 93
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2463
Mailing Address - Country:US
Mailing Address - Phone:843-281-8856
Mailing Address - Fax:
Practice Address - Street 1:2401 NOTTINGHAM WAY APT 93
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2463
Practice Address - Country:US
Practice Address - Phone:843-281-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056146945171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor