Provider Demographics
NPI:1831272236
Name:FIELDS, RODNEY DALE (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DALE
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HIGHLAND PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-6782
Mailing Address - Country:US
Mailing Address - Phone:706-698-2663
Mailing Address - Fax:706-698-2664
Practice Address - Street 1:309 HIGHLAND PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-6782
Practice Address - Country:US
Practice Address - Phone:706-698-2663
Practice Address - Fax:706-698-2664
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA173780118AMedicaid
GA20BBFTLMedicare ID - Type Unspecified
GAE93965Medicare UPIN