Individual
DR. ALI DODGE-KHATAMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, DIVISION OF PEDIATRIC CARDIAC SURGERY, JACKSON, MS 39216-4500
(601) 984-4693
Mailing address
2500 N STATE ST, DIVISION OF PEDIATRIC CARDIAC SURGERY, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
865-L
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05957764
—
MS
Enumeration date
04/01/2013
Last updated
02/18/2014
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