Organization
SANTA ROSA CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN CARLOS MALPARTIDA MD (DIRECTOR)
(706) 259-5579
Entity
Organization
Contact information
Practice address
1200 E WALNUT AVE, SUITE #4, DALTON, GA 30721-4196
(706) 259-5579
(706) 259-6558
Mailing address
1200 E WALNUT AVE, SUITE #4, DALTON, GA 30721-4196
(706) 259-5579
(706) 259-6558
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
050406
GA
261QA0600X
Adult Day Care Clinic/Center
053528
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034256F
—
GA
05
—
342515362A
—
GA
05
—
849865610-A
—
GA
Enumeration date
12/11/2007
Last updated
05/30/2008
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