Individual
MICHAEL A DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2347 LENORA CHURCH RD, SNELLVILLE, GA 30078-3232
(770) 979-2020
(770) 978-3321
Mailing address
2347 LENORA CHURCH RD, SNELLVILLE, GA 30078-3232
(770) 979-2020
(770) 978-3321
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
033954
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00475098A
—
GA
Enumeration date
11/03/2005
Last updated
06/23/2016
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