Healthcare Provider Details

I. General information

NPI: 1982988416
Provider Name (Legal Business Name): ROBERT J ROSS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S MILLEDGE AVE STE 140
ATHENS GA
30605-1387
US

IV. Provider business mailing address

1160 S MILLEDGE AVE STE 140
ATHENS GA
30605-1387
US

V. Phone/Fax

Practice location:
  • Phone: 706-352-9437
  • Fax: 855-461-3233
Mailing address:
  • Phone: 706-352-9437
  • Fax: 855-461-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: