1205352093 NPI number — ELITE ROSE HEALTHCARE SERVICES P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205352093 NPI number — ELITE ROSE HEALTHCARE SERVICES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE ROSE HEALTHCARE SERVICES P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205352093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2783 SANTA BARBARA DR NW
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:
30318-7326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2783 SANTA BARBARA DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30318-7326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-944-1174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
AYJANAH
Authorized Official Middle Name:
RASHEEDA
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
404-944-1174

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  APRN207446 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com