Provider Demographics
NPI:1952471070
Name:RODMAN, JOHN P SR (CPO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:RODMAN
Suffix:SR
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 LEDO RD STE 25
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1277
Mailing Address - Country:US
Mailing Address - Phone:229-430-9778
Mailing Address - Fax:229-430-1347
Practice Address - Street 1:2925 LEDO RD STE 25
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1277
Practice Address - Country:US
Practice Address - Phone:229-430-9778
Practice Address - Fax:229-430-1347
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPO14691744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management