Provider Demographics
NPI:1437993094
Name:DODSON, TABATHA
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TABATHA
Other - Middle Name:
Other - Last Name:WESTMORELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:543 BRENSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4904
Mailing Address - Country:US
Mailing Address - Phone:404-957-8548
Mailing Address - Fax:
Practice Address - Street 1:543 BRENSTON BLVD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-4904
Practice Address - Country:US
Practice Address - Phone:404-957-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician