Provider Demographics
NPI:1740451129
Name:RODRIGUEZ, DORIS JEAN (PHD, RN, C-PNP/PC)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:JEAN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD, RN, C-PNP/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PUTMANS HEAD
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1238
Mailing Address - Country:US
Mailing Address - Phone:770-843-8787
Mailing Address - Fax:
Practice Address - Street 1:1015 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6653
Practice Address - Country:US
Practice Address - Phone:404-523-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123156363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics