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General NPI Number Information
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NPI Number | 1780188912
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Entity Type | Individual
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Provider Name | ISAIAH JARELL ROLLE PH.D., D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-3440
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Country | US
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Telephone | 404-727-8234
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Fax |
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Provider Business Mailing Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-3440
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Country | US
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Telephone | 614-556-5456
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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 | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 92659
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | TPOS668
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 92659
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License Number State | GA
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