Provider Demographics
NPI:1134756257
Name:RODRIQUES, KADISHA ROXANNE (MD)
Entity type:Individual
Prefix:
First Name:KADISHA
Middle Name:ROXANNE
Last Name:RODRIQUES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 LIBERTY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5454
Mailing Address - Country:US
Mailing Address - Phone:678-533-8811
Mailing Address - Fax:
Practice Address - Street 1:203 WOODPARK PL STE 100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3705
Practice Address - Country:US
Practice Address - Phone:770-926-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA96901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program