| Organization Name: | RIVERDALE MEDICAL CENTER LLC |
| NPI Number: | 1033496070 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHELLY MORELAND (MANAGER) |
| Mailing Address: | 189 Medical Way Suite B Riverdale |
| State: | GA US |
| Postal Code: | 302744905 |
| Phone Number: | 7709072333 |
| Fax Number: | 7709072299 |
| NPI Enumeration Date: | 11/04/2011 |
| NPI Last Update Date: | 11/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2081P2900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Physical Medicine & Rehabilitation |
| Taxonomy Specialization: | Pain Medicine |
| Taxonomy Definition: | A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |