Provider Demographics
NPI:1770542417
Name:RAKER, RODNEY A (DPM)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:RAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1781
Mailing Address - Country:US
Mailing Address - Phone:229-242-3668
Mailing Address - Fax:229-253-8666
Practice Address - Street 1:679 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1146
Practice Address - Country:US
Practice Address - Phone:706-335-4884
Practice Address - Fax:706-336-8798
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000929213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00928771AMedicaid
GAP00012281OtherRAILROAD MEDICARE
GA0266960002Medicare NSC
GAU87097Medicare UPIN
GAP00012281OtherRAILROAD MEDICARE
GA48SCCLZMedicare PIN