Provider Demographics
NPI:1457390528
Name:MON, RODRIGO (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:MON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5461 MERIDIAN MARK RD STE 570
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2807
Mailing Address - Country:US
Mailing Address - Phone:404-785-6895
Mailing Address - Fax:404-785-6896
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 570
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2807
Practice Address - Country:US
Practice Address - Phone:404-785-6895
Practice Address - Fax:404-785-6896
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA89583208600000X
MI4301108618390200000X
DCMD045742390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery