MEDICARE: KEVIN J. RODBELL, 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

General Provider Information

NPI Number	:	1659672608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN J. RODBELL, MD

Provider Business Mailing Address
First Line	:	1799 BRIARCLIFF RD NE
Second Line	:	SUITE X
City	:	ATLANTA
State	:	GA
Zip	:	30306-2142
Country	:	US
Telephone Number	:	404-745-4578
Fax Number	:	404-745-4579

Provider Business Practice Location Address
First Line	:	1799 BRIARCLIFF RD NE
Second Line	:	SUITE X
City	:	ATLANTA
State	:	GA
Zip	:	30306-2142
Country	:	US
Telephone Number	:	404-745-4578
Fax Number	:	404-745-4579

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN JOSEPH RODBELL
Credential	:	MD
Telephone Number	:	404-745-4578

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	11/08/2010

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