Organization
ROCKBRIDGE WEST PARK MEDICAL ASSOCIATION PC MEDICAL OFFICE
Active
Organization
ROCKBRIDGE WEST PARK MEDICAL ASSOCIATION PC MEDICAL OFFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TADEUSZ WODECKI M.D. (PHYSICIAN)
(770) 413-1300
Entity
Organization
Contact information
Practice address
2256 ROCKBRIDGE RD, STONE MOUNTAIN, GA 30087-3517
(770) 413-1300
Mailing address
2256 ROCKBRIDGE RD, STONE MOUNTAIN, GA 30087-3517
(770) 413-1300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
029264
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00543397A
—
GA
01
—
1619994472
NPI
—
Enumeration date
12/30/2014
Last updated
01/07/2015
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