Healthcare Provider Details

I. General information

NPI: 1295956902
Provider Name (Legal Business Name): CHARLES L. RODGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BUENA VISTA RD
COLUMBUS GA
31906-3121
US

IV. Provider business mailing address

2201 BUENA VISTA RD
COLUMBUS GA
31906-3121
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-9012
  • Fax: 706-320-9021
Mailing address:
  • Phone: 706-320-9012
  • Fax: 706-320-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number030202
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: