Individual
DR. PATRICE D BODDIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
240 N WAYNE ST, MILLEDGEVILLE, GA 31061-3438
(478) 452-6999
(478) 452-7222
Mailing address
PO BOX 1219, MILLEDGEVILLE, GA 31059-1219
(478) 452-6999
(478) 452-7222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
027966
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00316852A
—
GA
05
—
00316852B
—
GA
01
—
52238029
BLUE CROSS/BLUE SHIELD
GA
01
—
581759458
TAX PAYER ID
GA
Enumeration date
09/30/2005
Last updated
10/13/2010
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