Organization
ROCKDALE SURGICAL CENTER
Active
Parent organization
ROCKDALE SURGICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROCKDALE SURGICAL CENTER
Authorized official
LYNWOOD CLEAVELAND (DOCTOR)
(770) 760-0182
Entity
Organization
Contact information
Practice address
4122 TATE ST NE, COVINGTON, GA 30014-2551
(770) 760-0182
(770) 483-3291
Mailing address
4122 TATE ST NE, COVINGTON, GA 30014-2551
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
023925
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00399506A
—
GA
Enumeration date
10/31/2007
Last updated
07/10/2019
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