Provider Demographics
NPI:1235128372
Name:RHODES, ROBERTA D I (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:D
Last Name:RHODES
Suffix:I
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1378
Mailing Address - Street 2:SOUTHWESTERN STATE HOSPITAL -PATIENT BILLING DEPT
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1378
Mailing Address - Country:US
Mailing Address - Phone:229-227-3004
Mailing Address - Fax:229-227-2663
Practice Address - Street 1:400 S PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-3004
Practice Address - Fax:229-227-2663
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ47556Medicare UPIN
GA71BBBRBMedicare ID - Type UnspecifiedMEDICARE PART B