Healthcare Provider Details

I. General information

NPI: 1194152751
Provider Name (Legal Business Name): EMPIRE STATE INPATIENT MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N JAMES ST
ROME NY
13440-2844
US

IV. Provider business mailing address

5901-C PEACHTREE-DUNWOODY ROAD, SUITE 350
ATLANTA GA
30328-7159
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-7000
  • Fax:
Mailing address:
  • Phone: 678-441-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODRICK GENAR LAWTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-441-8556