Individual
ELIZABETH DIANE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905-5650
(706) 787-2567
Mailing address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905-5650
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
89605
SC
Other
Enumeration date
07/19/2016
Last updated
09/18/2023
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