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Organization
RIVERDALE MEDICAL CENTER LLC
Active
Organization
RIVERDALE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY MORELAND (MANAGER)
(404) 543-6949
Entity
Organization
Contact information
Practice address
189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
(770) 907-2333
(770) 907-2299
Mailing address
189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
(770) 907-2333
(770) 907-2299
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
GA
208D00000X
General Practice Physician
Primary
—
GA
208VP0000X
Pain Medicine Physician
—
GA
208VP0014X
Interventional Pain Medicine Physician
—
GA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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