Healthcare Provider Details

I. General information

NPI: 1427033083
Provider Name (Legal Business Name): MARC ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1600
ATLANTA GA
30308-2209
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1620
ATLANTA GA
30308-2209
US

V. Phone/Fax

Practice location:
  • Phone: 404-881-1094
  • Fax: 404-885-7777
Mailing address:
  • Phone: 404-885-7701
  • Fax: 404-885-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number47360
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: