Healthcare Provider Details

I. General information

NPI: 1568657260
Provider Name (Legal Business Name): JENNIFER ROSSER PAVLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

770 PINE ST STE 290
MACON GA
31201-7516
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3167
  • Fax: 330-375-7932
Mailing address:
  • Phone: 317-805-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.099005
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020-02249
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: