Provider Demographics
NPI:1851301972
Name:RODEN, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:RODEN
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 1:320 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2432
Mailing Address - Country:US
Mailing Address - Phone:770-479-5535
Mailing Address - Fax:770-720-3294
Practice Address - Street 1:320 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2432
Practice Address - Country:US
Practice Address - Phone:770-479-5535
Practice Address - Fax:770-720-3294
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9796174400000X
GA026179207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161066AMedicaid
TX149600202Medicaid
TX8A8791Medicare PIN
GA202I203246Medicare PIN
TX149600202Medicaid