Provider Demographics
NPI:1649662982
Name:RODGERS, THOMAS JR (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RODGERS
Suffix:JR
Gender:M
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 LAWNDALE PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1637
Mailing Address - Country:US
Mailing Address - Phone:336-362-9930
Mailing Address - Fax:
Practice Address - Street 1:4105 LAWNDALE PL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1637
Practice Address - Country:US
Practice Address - Phone:336-362-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1103465133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic