Provider Demographics
NPI:1619934346
Name:RODGERS, DAVID PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD
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 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:1401 MAIN ST
Practice Address - Street 2:
Practice Address - City:BONNEAU
Practice Address - State:SC
Practice Address - Zip Code:29431-5013
Practice Address - Country:US
Practice Address - Phone:843-825-3404
Practice Address - Fax:843-825-3407
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080096524OtherRR MEDICARE
SC118795Medicaid
SCD177137555Medicare PIN
SC118795Medicaid
SCSC20017126Medicare PIN