Individual
JEFFREY IRA ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4385 JOHNS CREEK PKWY, STE 250, SUWANEE, GA 30024-6048
(770) 623-1608
(678) 992-2540
Mailing address
4385 JOHNS CREEK PKWY, STE 250, SUWANEE, GA 30024-6048
(770) 623-1608
(678) 992-2540
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
041654
GA
207YP0228X
Pediatric Otolaryngology Physician
041654
GA
207YX0602X
Otolaryngic Allergy Physician
041654
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000714381J
—
GA
05
—
000714381M
—
GA
Enumeration date
10/13/2005
Last updated
12/18/2009
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