MEDICARE: DOROTHY RODENBECK FERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	125071169	IL
2	207N00000X	Dermatology Physician	303345	NY
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207N00000X	Dermatology Physician	97882	GA

General Provider Information

NPI Number	:	1033572078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY RODENBECK FERNANDEZ MD

Provider Business Mailing Address
First Line	:	5730 GLENRIDGE DR STE T100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5730 GLENRIDGE DR STE T100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5747
Country	:	US
Telephone Number	:	404-939-9220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	08/08/2024

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