Provider Demographics
NPI:1962484055
Name:SNODGRASS, TIMOTHY J (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:SNODGRASS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DR STE G2
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-529-3245
Mailing Address - Fax:706-272-6077
Practice Address - Street 1:1107 MEMORIAL DR STE G2
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-529-3245
Practice Address - Fax:706-272-6077
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033202207Q00000X
FLOS6198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204593Medicaid
FL26355OtherSTAYWELL
FL371614700Medicaid
FL000013683GOtherHUMANA
FL80707AOtherMEDICARE
FL213210OtherAVMED
FL26355OtherSTAYWELL
FL80707AOtherMEDICARE