Provider Demographics
NPI:1861515868
Name:ROCKDALE PEDIATRICS HEALTHCARE, PC
Entity type:Organization
Organization Name:ROCKDALE PEDIATRICS HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARAKHSHAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:JARWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-922-0553
Mailing Address - Street 1:2020 HONEY CREEK PARKWAY SE,
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013
Mailing Address - Country:US
Mailing Address - Phone:770-922-0553
Mailing Address - Fax:770-922-6882
Practice Address - Street 1:2020 HONEY CREEK PARKWAY SE,
Practice Address - Street 2:SUITE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:770-922-0553
Practice Address - Fax:770-922-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty