Healthcare Provider Details

I. General information

NPI: 1467494120
Provider Name (Legal Business Name): RENE ROMERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 UPPERGATE DR
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

2015 UPPERGATE DR
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-2080
  • Fax: 404-727-4069
Mailing address:
  • Phone: 404-778-2080
  • Fax: 404-727-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number037060
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: