Provider Demographics
NPI:1255534194
Name:DHOPLE, ANIL A (MD)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:A
Last Name:DHOPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 DIXIE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3889
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-812-5735
Practice Address - Street 1:165 CLINIC AVE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4413
Practice Address - Country:US
Practice Address - Phone:770-836-9824
Practice Address - Fax:770-836-9850
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA865912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCP839YOtherMEDICARE
FL001696800Medicaid
MD413099500Medicaid
FL9103200OtherAETNA
MDSTATE LICENSEOtherD65673
FL001696800Medicaid
FL9103200OtherAETNA
MD413099500Medicaid