Rockbridge West Park Medical Association PC Medical Office

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

029264 Issued in GA

Legal business name

ROCKBRIDGE WEST PARK MEDICAL ASSOCIATION PC MEDICAL OFFICE

Practice address

2256 Rockbridge Rd
Stone Mountain, GA 30087-3517

Phone

(770) 413-1300

NPI assigned

Dec 30, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tadeusz Wodecki, M.D.NPI 1619994472

Title

Physician

Phone

(770) 413-1300

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tadeusz K Wodecki, MD

  • Internal Medicine Physician
  • Stone Mountain, GA
  • NPI 1619994472
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1326436221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2256 ROCKBRIDGE RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873517",
            "telephone_number": "770-413-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2256 ROCKBRIDGE RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873517",
            "telephone_number": "770-413-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKBRIDGE WEST PARK MEDICAL ASSOCIATION PC MEDICAL OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-30",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "WODECKI",
        "authorized_official_first_name": "TADEUSZ",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "770-413-1300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "029264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00543397A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619994472",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myriam K Robinson, CCC-SLP
• Zarinah N Robinson, LDO
• Robinwild Integrated Medicine LLC
• Robinwilde Integrated Medicine, LLLP
• Rock Health Inc
• Audrey Denise Rodgers, LCSW
• Niove Rodriguez
• Rolling Rose, Inc.
• Barbara Rollins
• Bruce Nicholas Rooney, MSW/LCSW

• Internal Medicine Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.