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General NPI Number Information
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NPI Number | 1295498178
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Entity Type | Individual
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Provider Name | RODARLINE GERARD CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 1133 EAGLES LANDING PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5085
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Country | US
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Telephone | 678-604-1053
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Fax |
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Provider Business Mailing Address
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Address Line | 901 HINDMAN PL
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City | MCDONOUGH
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State | GA
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Zip | 30253-8779
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Country | US
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Telephone | 678-651-4976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN261403
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN261403
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License Number State | GA
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