Provider Demographics
NPI:1336438845
Name:DODGEN, AMBER CATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CATHLEEN
Last Name:DODGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 OLD GATE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4770
Mailing Address - Country:US
Mailing Address - Phone:706-326-3082
Mailing Address - Fax:
Practice Address - Street 1:171 OLD GATE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4770
Practice Address - Country:US
Practice Address - Phone:706-326-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134859208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics