Healthcare Provider Details

I. General information

NPI: 1619144722
Provider Name (Legal Business Name): EMILY MARCINIAK ROOKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DIXIE ST
CARROLLTON GA
30117-4417
US

IV. Provider business mailing address

119 AMBULANCE DR SUITE 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-5831
  • Fax: 770-812-5832
Mailing address:
  • Phone: 770-838-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74639
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: