NPIMap

Organization Active NPI

Magnolia Surgery, PC

  • Surgery Physician
  • Kathleen, GA
National Provider Identifier
1982959615
Registry record updated Jan 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
23837 Issued in GA
Legal business name
MAGNOLIA SURGERY, PC
Practice address
1118 Highway 96 West
Suite 1
Kathleen, GA 31047
Phone
(478) 287-6574
Fax
(478) 287-6579
NPI assigned
Jul 18, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2013

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

Authorized official

Name
Dr. Kerry C. Rodgers, M.D.NPI 1669674909
Title
Physician/Owner
Phone
(478) 287-6574

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 23837 GA Primary

Addresses

Primary practice location

1118 Highway 96 West
Suite 1
Kathleen, GA 31047

Mailing address

1118 Highway 96 West
Suite 1
Kathleen, GA 31047
Phone (478) 287-6574

Other identifiers 2

IdentifierTypeStateIssuer
1669674909OtherGAINDIVIDUAL NPI#
003130442AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1801 Watson Blvd
Warner Robins, GA 31093

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359590400000",
    "number": "1982959615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 HIGHWAY 96 WEST",
            "address_2": "SUITE 1",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "31047",
            "telephone_number": "478-287-6574",
            "fax_number": "478-287-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 HIGHWAY 96 WEST",
            "address_2": "SUITE 1",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "31047",
            "telephone_number": "478-287-6574",
            "fax_number": "478-287-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2013-01-31",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "478-287-6574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "GA",
            "license": "23837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI#",
            "identifier": "1669674909",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003130442A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kathleen, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.