| Dmitri Kodor, PA-C | |
|
6330 Primrose Hill Ct, Norcross, GA 30092 | |
| (770) 343-8760 | |
| (770) 664-2101 |
| Full Name | Dmitri Kodor |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Medical |
| Location | 6330 Primrose Hill Ct, Norcross, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679883748 | NPI | - | NPPES |
| 003142752A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 02933 (Georgia) | Primary |
| Entity Name | Georgia Clinic, PC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609816123 PECOS PAC ID: 8426949587 Enrollment ID: O20040320000451 |
| Mailing Address | Practice Location Address |
|---|---|
| Dmitri Kodor, PA-C Po Box 769609, Roswell, GA 30076-8224 Ph: (770) 343-8760 | Dmitri Kodor, PA-C 6330 Primrose Hill Ct, Norcross, GA 30092 Ph: (770) 343-8760 |
Erica Maria Pena, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 6131 S Norcross Tucker Rd Ste 6, Norcross, GA 30093 Phone: 678-205-1959 |
Clinton M White, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 6920 Jimmy Carter Blvd, Ste. 100, Norcross, GA 30071 Phone: 770-449-0990 Fax: 770-448-8818 |
Deborah Gooden Adams Bowman, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 5127 Jimmy Carter Blvd, Norcross, GA 30093 Phone: 404-564-7016 Fax: 770-368-3846 |
Kristen Bradburn Oliver, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 5825 Buford Hwy Ste 300, Norcross, GA 30071 Phone: 678-993-0820 |
Rachael Maxwell, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 5825 Buford Hwy Ste 300, Norcross, GA 30071 Phone: 678-993-0820 |
Melissa Tucker Khan, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 6475 Jimmy Carter Blvd Ste 200, Norcross, GA 30071 Phone: 770-242-7744 |
Leandra Roshell Brown, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 5825 Buford Hwy, Norcross, GA 30071 Phone: 678-993-0820 |