MEDICARE: DR. SOPHIA M RODIER 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	207Q00000X	Family Medicine Physician	MD0000038104	TN

General Provider Information

NPI Number	:	1538108493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA M RODIER MD

Provider Business Mailing Address
First Line	:	5030 GEORGETOWN RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1309
Country	:	US
Telephone Number	:	423-303-2525
Fax Number	:	423-303-2528

Provider Business Practice Location Address
First Line	:	5030 GEORGETOWN RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1309
Country	:	US
Telephone Number	:	423-303-2525
Fax Number	:	423-303-2528

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/10/2008

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