Healthcare Provider Details

I. General information

NPI: 1841580099
Provider Name (Legal Business Name): CYNTHIA S ROLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 PINE ST STE 990
MACON GA
31201-7500
US

IV. Provider business mailing address

840 PINE ST STE 990
MACON GA
31201-7500
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-0404
  • Fax: 478-633-0805
Mailing address:
  • Phone: 478-633-0404
  • Fax: 478-633-0805

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number080392
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number80392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: