MEDICARE: DR. LEON RODGERS JR. EDD, MSW, MHDL, LCSW

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	1041C0700X	Clinical Social Worker	1195	GA

General Provider Information

NPI Number	:	1255493177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON RODGERS JR. EDD, MSW, MHDL, LCSW

Provider Business Mailing Address
First Line	:	2960 MACON RD
Second Line	:	SUITE 3080A
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2204
Country	:	US
Telephone Number	:	706-748-2195
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 MACON RD
Second Line	:	SUITE 3080A
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2204
Country	:	US
Telephone Number	:	706-748-2195
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	06/09/2015

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