MEDICARE: CHARLES B. ROSS MD

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	2086S0129X	Vascular Surgery Physician	24250	KY
2	2086S0129X	Vascular Surgery Physician	01066838A	IN
3	2086S0129X	Vascular Surgery Physician	068549	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	:	1326044330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES B. ROSS MD

Provider Business Mailing Address
First Line	:	95 COLLIER ROAD
Second Line	:	SUITE 5015
City	:	ATLANTA
State	:	GA
Zip	:	30309
Country	:	US
Telephone Number	:	404-605-5699
Fax Number	:	404-355-4235

Provider Business Practice Location Address
First Line	:	95 COLLIER ROAD
Second Line	:	SUITE 5015
City	:	ATLANTA
State	:	GA
Zip	:	30309
Country	:	US
Telephone Number	:	404-605-5699
Fax Number	:	404-355-4235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	12/10/2012

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Directions to “ CHARLES B. ROSS MD” Practice Location

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