# RIVERDALE MEDICAL CENTER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033496070
- **Authorized official:** SHELLY MORELAND (MANAGER)
- **Authorized official phone:** (404) 543-6949

## Contact information

- **Practice address:** 189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
- **Practice address phone:** (770) 907-2333
- **Practice address fax:** (770) 907-2299
- **Mailing address:** 189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
- **Mailing address phone:** (770) 907-2333
- **Mailing address fax:** (770) 907-2299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | GA | — |
| 208D00000X | General Practice Physician | — | GA | Yes |
| 208VP0000X | Pain Medicine Physician | — | GA | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | GA | — |

## Other

- **Enumeration date:** 11/04/2011
- **Last updated:** 11/04/2011