Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD000902 | GA |
NPI | 1063438745 |
---|---|
Provider Name | Dr. Jana M Rose |
First Address | Cornelia, GA 30531-1002 |
Second Address | Cornelia, GA 30531-5766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00871934C | (05) | GA |
P00631297 | RAILROAD MEDICARE (01) | GA |
U81117 | (02) |