Healthcare Provider Details

I. General information

NPI: 1093041584
Provider Name (Legal Business Name): ROCKDALE PSYCHIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 MANCHESTER DR NE
CONYERS GA
30012-3882
US

IV. Provider business mailing address

1397 MANCHESTER DR NE
CONYERS GA
30012-3882
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-0255
  • Fax: 770-922-3132
Mailing address:
  • Phone: 770-922-0255
  • Fax: 770-922-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number029066
License Number StateGA

VIII. Authorized Official

Name: DR. ANNAMARIE SPILLANE PAULSEN
Title or Position: OWNER
Credential: M.D.
Phone: 770-922-0255