Healthcare Provider Details

I. General information

NPI: 1477544591
Provider Name (Legal Business Name): JOSE O RODRIGUEZ-TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MARBLE MILL RD NW STE 101
MARIETTA GA
30060-7959
US

IV. Provider business mailing address

121 MARBLE MILL RD STE 101
MARIETTA GA
30060-7913
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-8315
  • Fax: 770-590-9170
Mailing address:
  • Phone: 770-422-8315
  • Fax: 770-590-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number024622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: