Healthcare Provider Details

I. General information

NPI: 1073910766
Provider Name (Legal Business Name): DARCY RODGERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 VICTORY DR
SWAINSBORO GA
30401-3235
US

IV. Provider business mailing address

467 E PULASKI HWY
METTER GA
30439-7526
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-4017
  • Fax: 478-237-3074
Mailing address:
  • Phone: 912-536-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT008940
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: