MEDICARE: DR. DAVID CARLSON ROE 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	208000000X	Pediatrics Physician	057658	GA

General Provider Information

NPI Number	:	1447214689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CARLSON ROE M.D.

Provider Business Mailing Address
First Line	:	1813 GREYSTONE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2620
Country	:	US
Telephone Number	:	404-351-6662
Fax Number	:	404-351-6030

Provider Business Practice Location Address
First Line	:	105 COLLIER RD NW
Second Line	:	SUITE 4060
City	:	ATLANTA
State	:	GA
Zip	:	30309-1710
Country	:	US
Telephone Number	:	404-351-6662
Fax Number	:	404-351-6030

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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