Provider Demographics
NPI:1962741686
Name:SUSAN DODD, MD, PLLC
Entity type:Organization
Organization Name:SUSAN DODD, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-690-7677
Mailing Address - Street 1:9314 PARKWEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4338
Mailing Address - Country:US
Mailing Address - Phone:865-690-7677
Mailing Address - Fax:865-690-7627
Practice Address - Street 1:9314 PARKWEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4338
Practice Address - Country:US
Practice Address - Phone:865-690-7677
Practice Address - Fax:865-690-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty