Healthcare Provider Details

I. General information

NPI: 1124235536
Provider Name (Legal Business Name): RODOLFO ROZINDO MACHADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 J DEWEY GRAY CIR STE 202
AUGUSTA GA
30909-6554
US

IV. Provider business mailing address

3623 J DEWEY GRAY CIR STE 202
AUGUSTA GA
30909-6554
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-8155
  • Fax:
Mailing address:
  • Phone: 706-922-9222
  • Fax: 706-922-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberLL34429
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number69351
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number69351
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: