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General NPI Number Information
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NPI Number | 1558679191
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Entity Type | Organization
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Legal Business Name | THEA ROSSI OD PC
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 890 DAWSONVILLE HWY STE A
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City | GAINESVILLE
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State | GA
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Zip | 30501-2607
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Country | US
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Telephone | 770-532-4591
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Fax |
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Provider Business Mailing Address
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Address Line | 172 HAYNES ST SW UNIT 113
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City | ATLANTA
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State | GA
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Zip | 30313-1377
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Country | US
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Telephone | 404-323-0168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THEA ROSSI
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Credential | O.D.
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Telephone | 404-323-0168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002127
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License Number State | GA
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