Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 042927 | GA |
Y | 208600000X | Surgeon | 042927 | GA |
NPI | 1013998905 |
---|---|
Provider Name | Dr. Rodovaldo Rodriguez JR. |
First Address | Dalton, GA 30720-3011 |
Second Address | Dalton, GA 30720-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000728604A | (05) | GA |
G39368 | (02) | GA |