Healthcare Provider Details

I. General information

NPI: 1689203754
Provider Name (Legal Business Name): YASMIN ROSSHANDLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 LAVISTA RD NE STE 100
ATLANTA GA
30329-3915
US

IV. Provider business mailing address

677 CHURCH STREET ATTN: GME
MARIETTA GA
30060
US

V. Phone/Fax

Practice location:
  • Phone: 404-982-8009
  • Fax:
Mailing address:
  • Phone: 770-793-5186
  • Fax: 770-793-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number94704
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: