MEDICARE: DR. JOHN WAYNE 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	207R00000X	Internal Medicine Physician	002280	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407955842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WAYNE ROSS MD

Provider Business Mailing Address
First Line	:	3915 CASCADE RD SW
Second Line	:	SUITE 310
City	:	ATLANTA
State	:	GA
Zip	:	30331-8512
Country	:	US
Telephone Number	:	404-696-1944
Fax Number	:	404-696-5705

Provider Business Practice Location Address
First Line	:	3915 CASCADE RD SW
Second Line	:	SUITE 310
City	:	ATLANTA
State	:	GA
Zip	:	30331-8512
Country	:	US
Telephone Number	:	404-696-1944
Fax Number	:	404-696-5705

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/21/2016

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