Individual provider Active NPI

Eduard Castejon Rosales

  • Student in an Organized Health Care Education/Training Program
  • Dunwoody, GA
National Provider Identifier
1487413662
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
111156 Issued in GA
Practice address
4500 N Shallowford Rd
Dunwoody, GA 30338-6476
Phone
(404) 778-6920
Fax
(404) 778-6811
NPI assigned
Mar 18, 2024
Last updated
Jun 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 111156 GA Primary
Family Medicine Physician 207Q00000X 111156 GA

Addresses

Primary practice location

4500 N Shallowford Rd
Dunwoody, GA 30338-6476

Mailing address

4500 N Shallowford Rd
Dunwoody, GA 30338-6476
Phone (404) 778-6920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260616004900 GA Practitioner - Family Practice 9032550751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peachtree Immediate Care FP, LLCGroup PAC ID 3274559323, 328 clinicians

Practice addresses (Care Compare)

5419 Chamblee Dunwoody Rd
Dunwoody, GA 30338-4101
Phone (678) 284-2067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1487413662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 N SHALLOWFORD RD",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303386476",
            "telephone_number": "404-778-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 N SHALLOWFORD RD",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303386476",
            "telephone_number": "404-778-6920",
            "fax_number": "404-778-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTEJON ROSALES",
        "first_name": "EDUARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-18",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": "111156",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "111156",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunwoody, GA

Sources for this page

Verify at the official NPI Registry.