Provider Demographics
NPI:1669674909
Name:RODGERS, KERRY C (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:C
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3633
Mailing Address - Country:US
Mailing Address - Phone:478-923-0144
Mailing Address - Fax:478-923-3471
Practice Address - Street 1:1701 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3633
Practice Address - Country:US
Practice Address - Phone:478-923-0144
Practice Address - Fax:478-923-3471
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23837208600000X
NY239120208600000X
GA067748208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128727AMedicaid
GA003128727FMedicaid
WV1669674909OtherMOUNTAINS STATE BCBS
WV151585807OtherFEDERAL BLACK LUNG PROGRAM
WV151585807OtherFEDERAL BLACK LUNG PROGRAM