Provider Demographics
NPI:1821069113
Name:FITZGIBBON, RODNEY II (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:FITZGIBBON
Suffix:II
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 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:3000 NE MEDICAL PARK
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6251
Practice Address - Country:US
Practice Address - Phone:803-736-6262
Practice Address - Fax:803-699-1934
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128828Medicaid
SCD790387654Medicare PIN
SCD79038Medicare UPIN
SC128828Medicaid