Provider Demographics
NPI:1992828289
Name:JOHNSON, RODNEY MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:MARC
Last Name:JOHNSON
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 1:229 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2969
Mailing Address - Country:US
Mailing Address - Phone:478-353-1058
Mailing Address - Fax:478-238-0841
Practice Address - Street 1:229 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2969
Practice Address - Country:US
Practice Address - Phone:478-353-1058
Practice Address - Fax:478-238-0841
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64841207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I032517OtherMEDICARE PTAN
GA003110844PMedicaid