Dmitri Kodor, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

02933 Issued in GA

Practice address

6330 Primrose Hill CT
Norcross, GA 30092

Phone

(770) 343-8760

Fax

(770) 664-2101

NPI assigned

Oct 7, 2010

Last updated

Jun 24, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Clinic, PC

  • Multi-Specialty Clinic/Center
  • Dunwoody, GA
  • NPI 1609816123
  Medicare reassignment
• Gwinnett Cardiology Services LLC

  • Cardiovascular Disease Physician
  • Lawrenceville, GA
  • NPI 1306185491
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1679883748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 769609",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300768224",
            "telephone_number": "770-343-8760",
            "fax_number": "770-664-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6330 PRIMROSE HILL CT",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "770-343-8760",
            "fax_number": "770-664-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODOR",
        "first_name": "DMITRI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-07",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "02933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003142752A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tae Young Kim, PT
• Young Kyong Kim, PH.D., LMFT
• King David Community Center of Atlanta, Inc. (Adult Care)
• Ko-Am Gwinnett Medical
• Yeunie Ko
• Keila Jenae Kolden
• Caroline Konadu
• Nicholas Kongoasa, MD, FACOG
• Korean Traditional Acupuncture LLC
• Grace Koucheravy, FNP

• Medical Physician Assistant in Norcross, GA
• Providers in Norcross, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.