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General NPI Number Information
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NPI Number | 1982861209
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA SURGERY AND COMPREHENSIVE BREAST CENTER
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 1504 N THORNTON AVE SUITE 101
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City | DALTON
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State | GA
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Zip | 30720-8394
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Country | US
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Telephone | 706-275-9000
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Fax | 706-226-6642
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Provider Business Mailing Address
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Address Line | 1504 N THORNTON AVE SUITE 101
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City | DALTON
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State | GA
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Zip | 30720-8394
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Country | US
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Telephone | 706-275-9000
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Fax | 706-226-6642
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Authorized Official
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Title or Position | OWNER
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Name | RODOVALDO RODRIGUEZ
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Credential | MD
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Telephone | 706-275-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042927
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License Number State | GA
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