Individual
JACK R. ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
610 19TH ST, COLUMBUS, GA 31901-1528
(706) 322-7884
(706) 660-2168
Mailing address
PO BOX 9247, COLUMBUS, GA 31908-9247
(706) 322-7884
(706) 660-2168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27302
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000340469E
—
GA
05
—
00340469B
—
GA
01
—
080031159
RAIL ROAD MEDICARE
GA
01
—
202I081215
MEDICARE PTAN
GA
Enumeration date
07/27/2006
Last updated
05/06/2015
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