Provider Demographics
NPI:1295877066
Name:DOUGLAS P DOZIER MD PC
Entity type:Organization
Organization Name:DOUGLAS P DOZIER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOZIER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:478-477-9412
Mailing Address - Street 1:4000 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5038
Mailing Address - Country:US
Mailing Address - Phone:478-477-9412
Mailing Address - Fax:800-618-8689
Practice Address - Street 1:4000 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5038
Practice Address - Country:US
Practice Address - Phone:478-477-9412
Practice Address - Fax:800-618-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015372207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA260744826AMedicare PIN