Healthcare Provider Details

I. General information

NPI: 1578765855
Provider Name (Legal Business Name): DR. MATTHEW DALE RODGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S JACKSON SPRINGS RD
MACON GA
31211-1439
US

IV. Provider business mailing address

CMR 402 UNIT 33100
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-3552
  • Fax: 478-259-6170
Mailing address:
  • Phone: 314-590-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number0016970
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number323034
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number95572
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24609
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: