Healthcare Provider Details

I. General information

NPI: 1033806435
Provider Name (Legal Business Name): THE ROUSE FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 NEWNAN ROAD
CARROLLTON GA
30117
US

IV. Provider business mailing address

PO BOX 2546
CARROLLTON GA
30112-0047
US

V. Phone/Fax

Practice location:
  • Phone: 770-328-5458
  • Fax:
Mailing address:
  • Phone: 770-328-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSALIND SMITH
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 404-293-6979