Provider Demographics
NPI:1669592481
Name:RODDY, WALTER F JR (RNFA)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:F
Last Name:RODDY
Suffix:JR
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3531 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4352
Mailing Address - Country:US
Mailing Address - Phone:770-932-8913
Mailing Address - Fax:770-932-9580
Practice Address - Street 1:3531 HANOVER DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4352
Practice Address - Country:US
Practice Address - Phone:770-932-8913
Practice Address - Fax:770-932-9580
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN054700163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant