Individual
DR. JIM W RODERIQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
955 SPRING ST NW, ATLANTA, GA 30309-3821
(404) 872-4263
(404) 873-2455
Mailing address
955 SPRING ST NW, ATLANTA, GA 30309-3821
(404) 872-4263
(404) 873-2455
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
024075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00257408B
—
GA
Enumeration date
07/22/2006
Last updated
07/08/2007
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