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General NPI Number Information
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NPI Number | 1578951190
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Entity Type | Organization
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Legal Business Name | MIDDLE GEORGIA ALLERGY AND ASTHMA LLC
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 229 INDUSTRIAL BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-2969
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Country | US
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Telephone | 478-353-1058
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Fax | 478-238-0841
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Provider Business Mailing Address
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Address Line | 229 INDUSTRIAL BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-2969
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Country | US
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Telephone | 478-353-1058
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Fax | 478-238-0841
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RODNEY JOHNSON
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Credential | M.D.
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Telephone | 478-353-1058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 64841
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License Number State | GA
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