Provider Demographics
NPI:1891944708
Name:RODNEY, JOHN ROCCO MACMILLAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN ROCCO
Middle Name:MACMILLAN
Last Name:RODNEY
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 1:3030 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5048
Mailing Address - Country:US
Mailing Address - Phone:901-383-8889
Mailing Address - Fax:901-384-6309
Practice Address - Street 1:3030 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5048
Practice Address - Country:US
Practice Address - Phone:901-383-8889
Practice Address - Fax:901-384-6309
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45956207P00000X, 207Q00000X, 208D00000X, 207QA0401X
TXN4707207P00000X, 207Q00000X
KY56738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DE870OtherBCBS
TXN4707OtherLICENSE
TX210899503Medicaid
TN1521174Medicaid
TN1521174Medicaid