Provider Demographics
NPI:1912523085
Name:PRODOEHL, JULIA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:PRODOEHL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PRISMA HEALTH MEDICAL GROUP ORTHOPEDIC SURGERY
Mailing Address - Street 2:2 MEDICAL PARK, STE 105
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6812
Mailing Address - Fax:803-434-7306
Practice Address - Street 1:PRISMA HEALTH MEDICAL GROUP ORTHOPEDIC SURGERY
Practice Address - Street 2:2 MEDICAL PARK, STE 105
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6812
Practice Address - Fax:803-434-7306
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
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Provider Licenses
StateLicense IDTaxonomies
SCLL84588207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery