Healthcare Provider Details

I. General information

NPI: 1588529671
Provider Name (Legal Business Name): ROSEMARY MBURU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 BRIDGE MILL AVE
CANTON GA
30114-7762
US

IV. Provider business mailing address

1337 BRIDGE MILL AVE
CANTON GA
30114-7762
US

V. Phone/Fax

Practice location:
  • Phone: 404-457-9207
  • Fax:
Mailing address:
  • Phone: 404-457-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberPHCP043680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: