Provider Demographics
NPI:1588893200
Name:RODRIGUEZ, SANDRA M (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:121 MARBLE MILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1110
Mailing Address - Country:US
Mailing Address - Phone:770-422-8315
Mailing Address - Fax:770-590-9170
Practice Address - Street 1:121 MARBLE MILL RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7959
Practice Address - Country:US
Practice Address - Phone:770-422-8315
Practice Address - Fax:770-590-9170
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA68787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics