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General NPI Number Information
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NPI Number | 1982959615
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SURGERY, PC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 1118 HIGHWAY 96 WEST SUITE 1
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City | KATHLEEN
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State | GA
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Zip | 31047
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Country | US
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Telephone | 478-287-6574
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Fax | 478-287-6579
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Provider Business Mailing Address
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Address Line | 1118 HIGHWAY 96 WEST SUITE 1
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City | KATHLEEN
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State | GA
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Zip | 31047
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Country | US
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Telephone | 478-287-6574
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Fax | 478-287-6579
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. KERRY C. RODGERS
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Credential | M.D.
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Telephone | 478-287-6574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 23837
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License Number State | GA
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