Provider Demographics
NPI:1962488510
Name:DODD, DAVID D (OPA-C, CSA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:D
Last Name:DODD
Suffix:
Gender:M
Credentials:OPA-C, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-7722
Mailing Address - Country:US
Mailing Address - Phone:770-205-1233
Mailing Address - Fax:770-205-0483
Practice Address - Street 1:234 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:BALL GROUND
Practice Address - State:GA
Practice Address - Zip Code:30107-7722
Practice Address - Country:US
Practice Address - Phone:770-205-1233
Practice Address - Fax:770-205-0483
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA200361406OtherEIN