Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 001370 | GA |
NPI | 1619059649 |
---|---|
Provider Name | Dr. Gail Callard Roeske |
First Address | Smyrna, GA 30082-2625 |
Second Address | Smyrna, GA 30082-2626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U22549 | (02) | GA |