Healthcare Provider Details

I. General information

NPI: 1861301939
Provider Name (Legal Business Name): ROSETTE ADELA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 HIGHWAY 138 SE STE 1K
CONYERS GA
30013-5723
US

IV. Provider business mailing address

1540 HIGHWAY 138 SE STE 1K
CONYERS GA
30013-5723
US

V. Phone/Fax

Practice location:
  • Phone: 770-873-4772
  • Fax:
Mailing address:
  • Phone: 770-873-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number122171
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: