Healthcare Provider Details

I. General information

NPI: 1013972074
Provider Name (Legal Business Name): JEFFREY STEVEN ROSENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1688 MULBERRY LAKE DR
DACULA GA
30019-4639
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-1960
  • Fax:
Mailing address:
  • Phone: 678-482-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number27903
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: