Healthcare Provider Details

I. General information

NPI: 1740451129
Provider Name (Legal Business Name): DORIS JEAN RODRIGUEZ PHD, RN, C-PNP/PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DONALD LEE HOLLOWELL PKWY NW
ATLANTA GA
30318-6653
US

IV. Provider business mailing address

105 PUTMANS HEAD
PEACHTREE CITY GA
30269-1238
US

V. Phone/Fax

Practice location:
  • Phone: 404-523-6571
  • Fax:
Mailing address:
  • Phone: 770-843-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN123156
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: