MEDICARE: DR. JOAN E RODRIGUEZ AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AUD001299	GA

General Provider Information

NPI Number	:	1043313422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN E RODRIGUEZ AUD

Provider Business Mailing Address
First Line	:	4245 JOHNS CREEK PKWY STE D
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6038
Country	:	US
Telephone Number	:	770-495-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	4245 JOHNS CREEK PKWY STE D
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6038
Country	:	US
Telephone Number	:	770-495-3820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	04/07/2008

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