Provider Demographics
NPI:1578765855
Name:RODGERS, MATTHEW DALE
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DALE
Last Name:RODGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 UNIT 33100
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:314-590-4281
Mailing Address - Fax:
Practice Address - Street 1:1140 S JACKSON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1439
Practice Address - Country:US
Practice Address - Phone:478-238-3552
Practice Address - Fax:478-259-6170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0016970207QS1201X
NY323034207QS1201X
GA95572207QS1201X
NE24609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine