Healthcare Provider Details

I. General information

NPI: 1780609867
Provider Name (Legal Business Name): RODRIGO E MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 TOMMY STALNAKER DR
WARNER ROBINS GA
31088-9179
US

IV. Provider business mailing address

92 TOMMY STALNAKER DR
WARNER ROBINS GA
31088-9179
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-2522
  • Fax: 478-333-3160
Mailing address:
  • Phone: 478-333-2522
  • Fax: 478-333-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number052467
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number052467
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number052467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: