Provider Demographics
NPI:1679371314
Name:DODSON, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DODSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1309
Mailing Address - Country:US
Mailing Address - Phone:317-989-7179
Mailing Address - Fax:
Practice Address - Street 1:1006 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1309
Practice Address - Country:US
Practice Address - Phone:317-989-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator