1497749105 NPI number — JANET L ROSS RN, FNP-C

Table of content: JANET L ROSS RN, FNP-C (NPI 1497749105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497749105 NPI number — JANET L ROSS RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
JANET
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-C
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:
1497749105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1168 N. MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
CEDARTOWN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30125-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-749-1005
Provider Business Mailing Address Fax Number:
770-749-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 EVANS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCHANAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30113-3086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-863-3221
Provider Business Practice Location Address Fax Number:
732-307-6950
Provider Enumeration Date:
09/08/2005

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: 363LF0000X , with the licence number:  APRN-NP070037 , 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: 747377872G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 747377872L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 747377872K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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