Roderique, Jim W
Roderique, Jim W is an sole proprietor health care provider with primary practice located at 955 Spring St Nw , Atlanta GA 30309-3821. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hand Surgery, which is considered as his primary health care specialty. Roderique, Jim W can be contacted via phone (404) 872-4263.Contact Information
Primary practice address
955 Spring St Nw
Atlanta GA 30309-3821
Phone: (404) 872-4263
Fax: (404) 873-2455
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hand Surgery | 207XS0106X | 024075 | Georgia |
Profile Details
| NPI number | 1205857307 |
|---|---|
| LBN Legal business name | Roderique, Jim W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 22nd, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205857307 | NPPES |
| Georgia | MEDICAID | 00257408B |
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