Healthcare Provider Details

I. General information

NPI: 1912861840
Provider Name (Legal Business Name): ROXANA TOMOIAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PEACHTREE ST NE
ATLANTA GA
30309-7649
US

IV. Provider business mailing address

3905 PORTICO RUN DR
BUFORD GA
30519-8415
US

V. Phone/Fax

Practice location:
  • Phone: 480-666-8275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: