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General NPI Number Information
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NPI Number | 1396651204
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Entity Type | Individual
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Provider Name | MARY ROSS
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Gender | Female
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Dates
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Enumeration Date | 08/20/2026
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 1202 TOWN PARK LN STE 300
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City | EVANS
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State | GA
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Zip | 30809-3477
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Country | US
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Telephone | 844-669-0429
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Fax |
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Provider Business Mailing Address
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Address Line | 3406 GROVE LANDING CIR
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City | GROVETOWN
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State | GA
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Zip | 30813-7014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP221505
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License Number State | GA
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