Individual
DAVID DEROSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1499 FAIR RD, STATESBORO, GA 30458-1683
(704) 662-5544
Mailing address
598 3RD ST, MACON, GA 31201-3357
(478) 633-6706
(478) 633-5384
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN135847
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000932236B
PEACHSTATE
GA
05
—
000932236B
—
GA
01
—
344303
WELLCARE
GA
01
—
P00115347
RAILROAD MEDICARE
GA
Enumeration date
11/15/2006
Last updated
12/19/2013
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