Healthcare Provider Details

I. General information

NPI: 1699777474
Provider Name (Legal Business Name): BARRY J ROSEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W PACES FERRY RD NW SUITE 204
ATLANTA GA
30327-2308
US

IV. Provider business mailing address

1218 W PACES FERRY RD NW SUITE 204
ATLANTA GA
30327-2308
US

V. Phone/Fax

Practice location:
  • Phone: 404-841-6262
  • Fax: 888-343-1740
Mailing address:
  • Phone: 404-841-6262
  • Fax: 888-343-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number67600
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number67600
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: