Provider Demographics
NPI:1235336538
Name:RODRIGUEZ, FRED HENRY III (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:HENRY
Last Name:RODRIGUEZ
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2835 BRANDYWINE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5510
Mailing Address - Country:US
Mailing Address - Phone:404-256-2593
Mailing Address - Fax:770-488-9408
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-5510
Practice Address - Country:US
Practice Address - Phone:404-256-2593
Practice Address - Fax:770-488-9408
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-01-25
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Provider Licenses
StateLicense IDTaxonomies
GA0682912080P0202X
GA68291207RA0002X, 2080P0202X
TXN6621207R00000X
LAMD.200631207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1078373Medicaid
TX220263201Medicaid
TX220263201Medicaid
LAB61338Medicare UPIN