Provider Demographics
NPI:1104986827
Name:RODRIGUEZ-FEO, CARLOS (RPH)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:RODRIGUEZ-FEO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 OLD LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4127
Mailing Address - Country:US
Mailing Address - Phone:706-353-1299
Mailing Address - Fax:706-743-3655
Practice Address - Street 1:778 ATHENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648
Practice Address - Country:US
Practice Address - Phone:706-743-5477
Practice Address - Fax:706-743-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12478183500000X
WV3333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12478OtherSTATE LICENSE NUMBER
WV3333OtherSTATE LICENSE NUMBER