Healthcare Provider Details

I. General information

NPI: 1992828289
Provider Name (Legal Business Name): RODNEY MARC JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 INDUSTRIAL BLVD
DUBLIN GA
31021-2969
US

IV. Provider business mailing address

229 INDUSTRIAL BLVD
DUBLIN GA
31021-2969
US

V. Phone/Fax

Practice location:
  • Phone: 478-353-1058
  • Fax: 478-238-0841
Mailing address:
  • Phone: 478-353-1058
  • Fax: 478-238-0841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64841
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number64841
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: