Healthcare Provider Details

I. General information

NPI: 1831272236
Provider Name (Legal Business Name): RODNEY DALE FIELDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 HIGHLAND PKWY SUITE 200
EAST ELLIJAY GA
30540-6782
US

IV. Provider business mailing address

309 HIGHLAND PKWY SUITE 200
EAST ELLIJAY GA
30540-6782
US

V. Phone/Fax

Practice location:
  • Phone: 706-698-2663
  • Fax: 706-698-2664
Mailing address:
  • Phone: 706-698-2663
  • Fax: 706-698-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number050367
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: