| Rockbridge West Park Medical Association Pc Medical Office | |
|
2256 Rockbridge Rd Stone Mountain GA 30087-3517 | |
| (770) 413-1300 | |
| Not Available |
| Full Name | Rockbridge West Park Medical Association Pc Medical Office |
|---|---|
| Speciality | Internal Medicine |
| Location | 2256 Rockbridge Rd, Stone Mountain, Georgia |
| Authorized Official Name and Position | Tadeusz Wodecki (PHYSICIAN) |
| Authorized Official Contact | 7704131300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockbridge West Park Medical Association Pc Medical Office 2256 Rockbridge Rd Stone Mountain GA 30087-3517 Ph: (770) 413-1300 | Rockbridge West Park Medical Association Pc Medical Office 2256 Rockbridge Rd Stone Mountain GA 30087-3517 Ph: (770) 413-1300 |
| NPI Number | 1326436221 |
|---|---|
| Provider Enumeration Date | 12/30/2014 |
| Last Update Date | 01/07/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326436221 | NPI | - | NPPES |
| 00543397A | Medicaid | GA | |
| 1619994472 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 029264 (Georgia) | Primary |
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