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Organization

MILLARD I. ROSS, M.D., LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MILLARD I ROSS JR. M.D. (CHAIRMAN)
(770) 713-2456
Entity
Organization

Contact information

Practice address
1412 MILSTEAD AVE NE, CONYERS, GA 30012-3877
(678) 413-7738
Mailing address
2724 HIGHWAY 212 SW, CONYERS, GA 30094-3370
(770) 213-2456
(770) 388-0539

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
15315
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000148552B
GA
Enumeration date
03/07/2008
Last updated
06/24/2008
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