Provider Demographics
NPI:1093480667
Name:RODRIGUEZ, JOSHUA TIBERIO (CAA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TIBERIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CAA
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Mailing Address - Street 1:7324 COOPERS HAWK DR
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-8237
Mailing Address - Country:US
Mailing Address - Phone:843-860-7332
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1611
Practice Address - Country:US
Practice Address - Phone:770-645-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant