Healthcare Provider Details

I. General information

NPI: 1265668271
Provider Name (Legal Business Name): STEVEN M. ROTH, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CENTRAL AVE
AUGUSTA GA
30904-6706
US

IV. Provider business mailing address

2101 CENTRAL AVE
AUGUSTA GA
30904-6706
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-8777
  • Fax: 706-738-2888
Mailing address:
  • Phone: 706-736-8777
  • Fax: 706-738-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. STEVEN MARK ROTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-736-8777