Provider Demographics
NPI:1891050381
Name:ROCKDALE PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:ROCKDALE PHYSICIAN PRACTICES LLC
Other - Org Name:ROCKDALE NEUROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1301 SIGMAN RD NE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3812
Mailing Address - Country:US
Mailing Address - Phone:770-918-3880
Mailing Address - Fax:
Practice Address - Street 1:1301 SIGMAN RD NE
Practice Address - Street 2:SUITE 225
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3812
Practice Address - Country:US
Practice Address - Phone:770-918-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty