MEDICARE: DR. JULIA KIRSTEN ROOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	200200590	NC
2	207Q00000X	Family Medicine Physician	21868	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01131300	OTHER	SC	RAILROAD MEDICARE
3	AA7340J577	OTHER	SC	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245299668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA KIRSTEN ROOS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 744786
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4786
Country	:	US
Telephone Number	:	704-834-2450
Fax Number	:	704-671-5331

Provider Business Practice Location Address
First Line	:	520 N DEKALB ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4188
Country	:	US
Telephone Number	:	704-484-8001
Fax Number	:	704-484-2485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	12/17/2025

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Directions to “ DR. JULIA KIRSTEN ROOS M.D.” Practice Location

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