Provider Demographics
NPI:1487740171
Name:RODBELL, KEVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:RODBELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1799 BRIARCLIFF ROAD NE
Mailing Address - Street 2:SUITE X
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306
Mailing Address - Country:US
Mailing Address - Phone:404-745-4578
Mailing Address - Fax:404-745-4579
Practice Address - Street 1:1799 BRIARCLIFF ROAD NE
Practice Address - Street 2:SUITE X
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306
Practice Address - Country:US
Practice Address - Phone:404-745-4578
Practice Address - Fax:404-745-4579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-12-02
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Provider Licenses
StateLicense IDTaxonomies
GA057998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA566873882HMedicaid