Healthcare Provider Details

I. General information

NPI: 1619800711
Provider Name (Legal Business Name): DR. RODERICK LEROY GUERRY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CHESTNUT HILL RD
BLACK MOUNTAIN NC
28711-8664
US

IV. Provider business mailing address

165 CHESTNUT HILL RD
BLACK MOUNTAIN NC
28711-8664
US

V. Phone/Fax

Practice location:
  • Phone: 828-337-1579
  • Fax:
Mailing address:
  • Phone: 828-337-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number10554
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: