Organization
MAGNOLIA SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERRY C. RODGERS M.D. (PHYSICIAN/OWNER)
(478) 287-6574
Entity
Organization
Contact information
Practice address
1118 HIGHWAY 96 WEST, SUITE 1, KATHLEEN, GA 31047
(478) 287-6574
(478) 287-6579
Mailing address
1118 HIGHWAY 96 WEST, SUITE 1, KATHLEEN, GA 31047
(478) 287-6574
(478) 287-6579
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
23837
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003130442A
—
GA
01
—
1669674909
INDIVIDUAL NPI#
GA
Enumeration date
07/18/2012
Last updated
01/31/2013
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