MEDICARE: NORTH GEORGIA UROLOGY GROUP, P.C.

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	2088P0231X	Pediatric Urology Physician	030370	GA

General Provider Information

NPI Number	:	1346422995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GEORGIA UROLOGY GROUP, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 879
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30703-0879
Country	:	US
Telephone Number	:	706-625-3822
Fax Number	:	706-625-8030

Provider Business Practice Location Address
First Line	:	101 PROFESSIONAL CT SE
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-7036
Country	:	US
Telephone Number	:	706-625-3822
Fax Number	:	706-625-8030

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. EDWARD LUIS ROJAS
Credential	:	M.D.
Telephone Number	:	706-625-3822

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	04/07/2008

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