Provider Demographics
NPI:1134563315
Name:WORTHINGTON, RODDIE
Entity type:Individual
Prefix:
First Name:RODDIE
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3115
Mailing Address - Country:US
Mailing Address - Phone:336-483-7737
Mailing Address - Fax:888-230-7096
Practice Address - Street 1:502 BEECH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3115
Practice Address - Country:US
Practice Address - Phone:336-483-7737
Practice Address - Fax:888-230-7096
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information