MEDICARE: DR. SANDRA M RODRIGUEZ M.D.

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	208000000X	Pediatrics Physician	68787	GA

General Provider Information

NPI Number	:	1588893200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA M RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	121 MARBLE MILL RD
Second Line	:	SUITE 101
City	:	MARIETTA
State	:	GA
Zip	:	30060-1110
Country	:	US
Telephone Number	:	770-422-8315
Fax Number	:	770-590-9170

Provider Business Practice Location Address
First Line	:	121 MARBLE MILL RD NW
Second Line	:	SUITE 101
City	:	MARIETTA
State	:	GA
Zip	:	30060-7959
Country	:	US
Telephone Number	:	770-422-8315
Fax Number	:	770-590-9170

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	10/02/2019

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