1225210925 NPI number — ROZA K ADAMCZYK MD PC

Table of content: (NPI 1225210925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225210925 NPI number — ROZA K ADAMCZYK MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROZA K ADAMCZYK MD PC
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:
1225210925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
618 S 8TH ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRIFFIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30224-4251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-227-1102
Provider Business Mailing Address Fax Number:
770-227-3082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 GOVERNORS SQ
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30215-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-486-8065
Provider Business Practice Location Address Fax Number:
770-227-3082
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARONSON
Authorized Official First Name:
LUBA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
770-227-1102

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  029568 , 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)

  • Identifier: 21003404108 . This is a "BEECHSTREET" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 328469 . This is a "WELLCARE - MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00347234G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4567388 . This is a "AETNA- PPO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52239078001 . This is a "BLUE CROSS BLUE SHILE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52239078002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00347234B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1020061 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2339303 . This is a "AETNA - HMO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11363 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10058864 . This is a "AMERIGROUP - MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 117715 . This is a "PEACHSTATE - MCAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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