1245299668 NPI number — DR. JULIA K ROOS M.D.

Table of content: KIMBERLY HANLEY (NPI 1992288641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245299668 NPI number — DR. JULIA K ROOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROOS
Provider First Name:
JULIA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245299668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 N DEKALB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-484-8001
Provider Business Practice Location Address Fax Number:
704-484-2485
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  21868 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 200200590 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01131300 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 89131XA , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA7340J577 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: L33998 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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