Individual
ANDREW F ROUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
200 ACADEMY STREET, GAINESVILLE, GA 30501
(770) 282-8820
Mailing address
PO BOX 2417, GAINESVILLE, GA 30503-2417
(770) 532-9936
(770) 534-9877
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004512
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510962418A
—
GA
05
—
510962418K
—
GA
01
—
581177261A
MEDICARE GRP PROV #
GA
01
—
P00298024
RAILROAD MEDICARE
GA
Enumeration date
10/11/2006
Last updated
01/13/2021
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