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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