Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 001242 | GA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 001242 | GA |
NPI | 1396827325 |
---|---|
Provider Name | Dr. Richard Alan Roeske |
First Address | Smyrna, GA 30082-2626 |
Second Address | Smyrna, GA 30082-2626 |
Gender | M |
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 |
---|---|---|
U16833 | (02) | GA |