Healthcare Provider Details

I. General information

NPI: 1639154347
Provider Name (Legal Business Name): ROBERTO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE STE 403
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

4700 WATERS AVE STE 403
SAVANNAH GA
31404-6220
US

V. Phone/Fax

Practice location:
  • Phone: 912-273-1150
  • Fax: 912-273-2811
Mailing address:
  • Phone: 912-273-1150
  • Fax: 912-273-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD439333
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberPA9119801
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number103127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: