Provider Demographics
NPI:1619028396
Name:ROCKDALE ANESTHESIA SERVICES, P.C.
Entity Type:Organization
Organization Name:ROCKDALE ANESTHESIA SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SELWYNN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-388-7745
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1078
Mailing Address - Country:US
Mailing Address - Phone:770-388-7745
Mailing Address - Fax:770-922-0526
Practice Address - Street 1:1359 MILSTEAD RD NE
Practice Address - Street 2:SUITE 103
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3865
Practice Address - Country:US
Practice Address - Phone:770-388-7745
Practice Address - Fax:770-922-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAJ711633207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty