Healthcare Provider Details

I. General information

NPI: 1851411102
Provider Name (Legal Business Name): AMBER MARTIN-ROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8954 HOSPITAL DR
DOUGLASVILLE GA
30134-2272
US

IV. Provider business mailing address

5405 WINDSOR GREEN CT SE
MABLETON GA
30126-5690
US

V. Phone/Fax

Practice location:
  • Phone: 770-920-6413
  • Fax:
Mailing address:
  • Phone: 773-844-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME107684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: