Provider Demographics
NPI:1831551340
Name:DODD, HENRY HILTON (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:HILTON
Last Name:DODD
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 1:401 ALCORN DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9071
Mailing Address - Country:US
Mailing Address - Phone:662-293-7390
Mailing Address - Fax:662-293-7399
Practice Address - Street 1:401 ALCORN DR STE 1B
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9071
Practice Address - Country:US
Practice Address - Phone:662-293-7390
Practice Address - Fax:662-293-7399
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26669208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00529313Medicaid
MSFD8363967OtherDEA