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General NPI Number Information
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NPI Number | 1538339338
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Entity Type | Organization
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Legal Business Name | MILLARD I. ROSS, M.D., LLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1412 MILSTEAD AVE NE
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City | CONYERS
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State | GA
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Zip | 30012-3877
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Country | US
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Telephone | 678-413-7738
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Fax |
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Provider Business Mailing Address
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Address Line | 2724 HIGHWAY 212 SW
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City | CONYERS
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State | GA
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Zip | 30094-3370
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Country | US
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Telephone | 770-213-2456
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Fax | 770-388-0539
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. MILLARD I ROSS JR.
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Credential | M.D.
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Telephone | 770-713-2456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 15315
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License Number State | GA
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