1285732495 NPI number — DR. JAMES ENOCH DOPSON M.D.

Table of content: DR. JAMES ENOCH DOPSON M.D. (NPI 1285732495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285732495 NPI number — DR. JAMES ENOCH DOPSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOPSON
Provider First Name:
JAMES
Provider Middle Name:
ENOCH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285732495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1918 NORTHLAKE PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TUCKER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30084-7070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-723-9318
Provider Business Mailing Address Fax Number:
770-723-0176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1918 NORTHLAKE PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084-7070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-723-9318
Provider Business Practice Location Address Fax Number:
770-723-0176
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  31587 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31587 . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00412475A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720953488 . This is a "TAX ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000040724 . This is a "MEDICAID REF#" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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