Provider Demographics
NPI:1285732495
Name:DOPSON, JAMES ENOCH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ENOCH
Last Name:DOPSON
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 1:1918 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7070
Mailing Address - Country:US
Mailing Address - Phone:770-723-9318
Mailing Address - Fax:770-723-0176
Practice Address - Street 1:1918 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7070
Practice Address - Country:US
Practice Address - Phone:770-723-9318
Practice Address - Fax:770-723-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31587174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA31587OtherSTATE LICENSE
GA00412475AMedicaid
GA720953488OtherTAX ID
GA000040724OtherMEDICAID REF#
GA000040724OtherMEDICAID REF#
GABD2092788OtherGA DEA #
GAB63371Medicare UPIN