Healthcare Provider Details

I. General information

NPI: 1285040618
Provider Name (Legal Business Name): PAOLA POLANCO ROSARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 COLLEGE AVE
ATHENS GA
30601
US

IV. Provider business mailing address

675 COLLEGE AVE
ATHENS GA
30601-2635
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-5526
  • Fax: 706-546-5687
Mailing address:
  • Phone: 706-546-5526
  • Fax: 706-546-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75818
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: