Healthcare Provider Details

I. General information

NPI: 1134148455
Provider Name (Legal Business Name): ANDREW H ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW
ATLANTA GA
30327-1610
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6880
  • Fax: 404-778-4295
Mailing address:
  • Phone: 561-866-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME89367
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number111263
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD25993
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: