Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 071278 | GA |
N | 207Q00000X | Family Doctor | LL1577 | SC |
N | 207QS0010X | Family Doctor - Sports Medicine | 03799 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 71278 | GA |
NPI | 1184986671 |
---|---|
Provider Name | Dr. Cortie J Rolison IV |
First Address | Atlanta, GA 30374-2616 |
Second Address | Hoschton, GA 30548-1897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015771 | (05) | SC |
NPI # | BLUE CHOICE COMMERCIAL (01) | SC |
NPI # | BLUE CHOICE MEDICAID (01) | SC |
NPI # | BLUE CROSS NETWORK (01) | SC |
NPI # | TRICARE (01) | SC |