Provider Demographics
NPI:1922691088
Name:ALEXANDER-RODRIGUEZ, AUDREY O (CSFA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:O
Last Name:ALEXANDER-RODRIGUEZ
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 LAWRENCEVILLE SUWANEE RD STE 12-385
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2648
Mailing Address - Country:US
Mailing Address - Phone:404-375-5393
Mailing Address - Fax:
Practice Address - Street 1:2133 LAWRENCEVILLE SUWANEE RD STE 12-385
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2648
Practice Address - Country:US
Practice Address - Phone:404-375-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
200761OtherTHE NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING