Provider Demographics
NPI:1013684778
Name:DODD, AMELIA HEATHER (NP-C)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:HEATHER
Last Name:DODD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GOOSE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-3344
Mailing Address - Country:US
Mailing Address - Phone:706-499-7427
Mailing Address - Fax:
Practice Address - Street 1:305 GOOSE CREEK LN
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-3344
Practice Address - Country:US
Practice Address - Phone:706-499-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN247827OtherADVANCED PRACTICE NP