Organization
THEA ROSSI OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEA ROSSI O.D. (OWNER)
(404) 323-0168
Entity
Organization
Contact information
Practice address
890 DAWSONVILLE HWY, STE A, GAINESVILLE, GA 30501-2607
(770) 532-4591
Mailing address
172 HAYNES ST SW UNIT 113, ATLANTA, GA 30313-1377
(404) 323-0168
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002127
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104884873
NPI (INDIVIDUAL)
—
Enumeration date
09/16/2010
Last updated
03/04/2011
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