Provider Demographics
NPI:1093041584
Name:ROCKDALE PSYCHIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:ROCKDALE PSYCHIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNAMARIE
Authorized Official - Middle Name:SPILLANE
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-922-0255
Mailing Address - Street 1:1397 MANCHESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3882
Mailing Address - Country:US
Mailing Address - Phone:770-922-0255
Mailing Address - Fax:770-922-3132
Practice Address - Street 1:1397 MANCHESTER DR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3882
Practice Address - Country:US
Practice Address - Phone:770-922-0255
Practice Address - Fax:770-922-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029066103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00516381BMedicaid