Healthcare Provider Details

I. General information

NPI: 1477920148
Provider Name (Legal Business Name): AMI ROSEN MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE STE 511
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

12 EXECUTIVE PARK DR NE STE 511
ATLANTA GA
30329-2206
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-3381
  • Fax: 404-712-8576
Mailing address:
  • Phone: 404-727-3381
  • Fax: 404-712-8576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: