Provider Demographics
NPI:1811944861
Name:RODTS, GERALD E JR (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:RODTS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERALD
Other - Middle Name:EDWARD
Other - Last Name:RODTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:59 EXECUTIVE PARK SOUTH
Mailing Address - Street 2:STE 3000 EMORY SPINE CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-778-5770
Mailing Address - Fax:404-778-5121
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH
Practice Address - Street 2:STE 3000 EMORY SPINE CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-778-6227
Practice Address - Fax:404-778-6310
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038082207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F94417Medicare UPIN
14BDCBTMedicare ID - Type Unspecified