MEDICARE: JENNIFER MARIE RODRIGUEZ M.D.

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	2084P0800X	Psychiatry Physician	060365	GA
2	2084P0800X	Psychiatry Physician	60365	GA

General Provider Information

NPI Number	:	1669659975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 LAKE HEARN DR STE 250&500
Second Line	:	BEHAVIORAL HEALTH KAISER PERMANENTE SANDY SPRINGS
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1523
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

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

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/13/2022

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