MEDICARE: ROCKDALE DIAGNOSTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053497826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKDALE DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	1700 HONEY CREEK COMMONS SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-5826
Country	:	US
Telephone Number	:	770-918-3100
Fax Number	:	770-918-3837

Provider Business Practice Location Address
First Line	:	1700 HONEY CREEK COMMONS SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-5826
Country	:	US
Telephone Number	:	770-918-3100
Fax Number	:	770-918-3837

Authorized Official
Title or Position	:	SUPERVISING MANAGER
Name	:	MRS. DEBORAH P ARMSTRONG
Credential	:
Telephone Number	:	770-918-3877

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/04/2008

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