Basic Information
| Provider Information | |||||||||
| NPI: | 1962484808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINKNEY | ||||||||
| FirstName: | ROLAND | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 745092 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303745092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707021806 | ||||||||
| FaxNumber: | 7706930810 | ||||||||
| Practice Location | |||||||||
| Address1: | 8954 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709206413 | ||||||||
| FaxNumber: | 6788382532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 044058 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP3000X | 044058 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 208VP0000X | 044058 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 044058 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | 044058 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000792921C | 05 | GA | MEDICAID | 000792921A | 05 | GA | MEDICAID | 491431789A | 05 | GA | MEDICAID |