Etienne Jose Rodriguez, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

067979 Issued in GA

Practice address

5471 Chamblee Dunwoody Rd
Dunwoody, GA 30338-4114

Phone

(770) 481-0889

Fax

(770) 481-0986

NPI assigned

Jun 5, 2009

Last updated

Sep 13, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Ponce School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Doctor on Demand Professionals P CGroup PAC ID 9436464567, 113 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: etienne.rodriguez.1@30520.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Doctor on Demand Professionals P C

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1174931448

  GA

  Medicare reassignment Care Compare group NPD
• Acworth Immediate Care LLC

  dba Acworth Immediate Care

  • Emergency Medicine Physician
  • Acworth, GA
  • NPI 1326218942
  NPD (past)
• Dunwoody Personal Health Care PC

  • Internal Medicine Physician
  • Dunwoody, GA
  • NPI 1811386022
  NPD (past)
• Memorial Health Urgentone, Inc.

  dba UrgentOne Godley Station

  • Emergency Medicine Physician
  • Pooler, GA
  • NPI 1083782189

  Family Medicine

  NPD (past)
• Memorial Health Urgentone, Inc.

  dba UrgentOne Savannah Mall

  • Emergency Medicine Physician
  • Savannah, GA
  • NPI 1801818844

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1679709539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5471 CHAMBLEE DUNWOODY RD",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303384114",
            "telephone_number": "770-481-0889",
            "fax_number": "770-481-0986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5471 CHAMBLEE DUNWOODY RD",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303384114",
            "telephone_number": "770-481-0889",
            "fax_number": "770-481-0986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "ETIENNE",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-05",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "81672",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2018-02700",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C159178",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101265867",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "067979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonel Roberson
• Megan Roberson, LCSW
• Luke Robert, DMD
• Mary Cameron Elizabeth Robert, DMD
• Jeff L Rodgers, DMD
• Marian Rogers, CRNA
• Marie-Danielle Romain, NP
• Sita C Romero, LMT, CD, HCHI
• Zen B Rondowsky, O.D.
• Rose Concierge Senior Services LLC

• Family Medicine Physician in Dunwoody, GA
• Providers in Dunwoody, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.