Tadeusz K Wodecki, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

029264 Issued in GA

Practice address

2256 Rockbridge Rd
Stone Mountain, GA 30087

Phone

(770) 413-1300

Fax

(770) 413-0547

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

General Practice

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Rockbridge West Park Medical Association PC Medical Office

  • Internal Medicine Physician
  • Stone Mountain, GA
  • NPI 1326436221
  NPD (past) Authorized official

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326758400000",
    "number": "1619994472",
    "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": "30087",
            "telephone_number": "770-413-1300",
            "fax_number": "770-413-0547"
        },
        {
            "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": "30087",
            "telephone_number": "770-413-1300",
            "fax_number": "770-413-0547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WODECKI",
        "first_name": "TADEUSZ",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "029264",
            "primary": true
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "NC",
            "license": "200301312",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619994472",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00543397A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Williams
• Laura Renae Wilson, MSN, APRN-BC
• Wilson's Wellness Clinical Care, LLC
• Annette Winkfield, MS, DCP, ST
• Stacy D Witherspoon
• Jo Anne Woodall, APRN
• Janay Lashaunda Wooden, HAIR REPLACEMENT SPE
• Erica Dionne Woods, LPC
• Thomas Crandall Woodson, ATC
• Wright Horizon

• 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 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.