Individual
DMITRI KODOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6330 PRIMROSE HILL CT, NORCROSS, GA 30092
(770) 343-8760
(770) 664-2101
Mailing address
PO BOX 769609, ROSWELL, GA 30076-8224
(770) 343-8760
(770) 664-2101
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
02933
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003142752A
—
GA
Enumeration date
10/07/2010
Last updated
06/24/2014
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