Individual ProviderNathaniel RodriguezInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1500 Oglethorpe Ave Ste 200d, Athens, GA 30606-2165(706) 389-3875(706) 389-3860PECOS EnrollmentBased on the most recent information from CMS, provider Nathaniel Rodriguez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1407315278Provider TypeIndividualFull NameRodriguez, NathanielTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date3/19/2019Last Updated4/3/2023Contact InformationPractice LocationPractice Address1500 Oglethorpe Ave Ste 200d, Athens, GA 30606-2165Phone(706) 389-3875FaxUnlisted FaxMailing LocationMailing Address1230 Baxter St, Athens, GA 30606-3712Phone(706) 389-3860Fax(706) 389-3861Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseMD.44658AlabamaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense10895GeorgiaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer