MEDICARE: DEANNA LYNNE ROY 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	34701	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1437197761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA LYNNE ROY M.D.

Provider Business Mailing Address
First Line	:	1505 LILBURN STONE MOUNTAIN RD
Second Line	:	STE 100
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1857
Country	:	US
Telephone Number	:	770-469-4131
Fax Number	:	770-469-3931

Provider Business Practice Location Address
First Line	:	1505 LILBURN STONE MOUNTAIN RD
Second Line	:	STE 100
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-1857
Country	:	US
Telephone Number	:	770-469-4131
Fax Number	:	770-469-3931

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/25/2024

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