Healthcare Provider Details

I. General information

NPI: 1417746603
Provider Name (Legal Business Name): ROSEMARIE MCLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 AVALON PKWY STE 345
MCDONOUGH GA
30253-3054
US

IV. Provider business mailing address

2020 AVALON PKWY STE 345
MCDONOUGH GA
30253-3054
US

V. Phone/Fax

Practice location:
  • Phone: 347-303-9452
  • Fax:
Mailing address:
  • Phone: 347-303-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number21094096
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number21094096
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number21094096
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number21094096
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number21094096
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: