Healthcare Provider Details

I. General information

NPI: 1962792366
Provider Name (Legal Business Name): ROGER FRANCIS EDUARDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BULLSBORO DR STE B-C
NEWNAN GA
30263-1680
US

IV. Provider business mailing address

3193 HOWELL MILL RD NW STE 125
ATLANTA GA
30327-2100
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-3230
  • Fax: 470-298-7732
Mailing address:
  • Phone: 470-419-4380
  • Fax: 470-298-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number83109
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: