MEDICARE: MRS. CIDJAH RODNEY-SOMERSALL MD

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	059751	GA

General Provider Information

NPI Number	:	1659562007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CIDJAH RODNEY-SOMERSALL MD

Provider Business Mailing Address
First Line	:	4525 TERESA CT
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-7702
Country	:	US
Telephone Number	:	678-471-6938
Fax Number	:

Provider Business Practice Location Address
First Line	:	2695 BUFORD HWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30324-3278
Country	:	US
Telephone Number	:	404-616-6999
Fax Number	:

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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