Healthcare Provider Details

I. General information

NPI: 1376145318
Provider Name (Legal Business Name): ROSS AND ASSOCIATES MEDICAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 UPPER RIVERDALE RD SW STE 107
RIVERDALE GA
30274-2642
US

IV. Provider business mailing address

145 ACORN DR
MCDONOUGH GA
30253-4703
US

V. Phone/Fax

Practice location:
  • Phone: 678-489-6734
  • Fax: 888-498-4760
Mailing address:
  • Phone: 678-749-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANTRANIKA D. ROSS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 678-749-5702