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Organization
CHILDREN'S MEDICINE OF ROCKDALE
Active
Organization
CHILDREN'S MEDICINE OF ROCKDALE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAN EYSIE (OWNER)
(404) 448-4652
Entity
Organization
Contact information
Practice address
1765 PARKER RD SE, SUITE B210, CONYERS, GA 30094-6652
(770) 761-0672
Mailing address
1765 PARKER RD, SUITE B210, CONYERS, GA 30094
(770) 761-0672
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
Other
Enumeration date
06/16/2009
Last updated
05/10/2012
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