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General NPI Number Information
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NPI Number | 1417937202
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Entity Type | Individual
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Provider Name | RODNEY SHAWN GONZALEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | MARTIN ARMY COMMUNITY HOSPITAL
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City | FT. BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone | 706-544-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 8116 HIGHLANDS DR
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City | MIDLAND
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State | GA
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Zip | 31820-4353
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Country | US
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Telephone | 706-568-6517
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 057300
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License Number State | GA
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