Rodger Henry Eidson, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

012695 Issued in GA

Practice address

1105 Burleyson Road
Dalton, GA 30720

Phone

(706) 278-4640

Fax

(706) 275-6599

NPI assigned

Apr 20, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1164649935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 BURLEYSON ROAD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-278-4640",
            "fax_number": "706-275-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 BURLEYSON ROAD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-278-4640",
            "fax_number": "706-275-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDSON",
        "first_name": "RODGER",
        "middle_name": "HENRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "012695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119743A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• David Ellis, LPC

• Obstetrics & Gynecology Physician in Dalton, GA
• Providers in Dalton, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.