Individual
DR. WILLIAM WAGNER ROSE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2675 N DECATUR RD, SUITE 701, DECATUR, GA 30033-6131
(404) 299-6488
(404) 299-7522
Mailing address
2675 N DECATUR RD, SUITE 701, DECATUR, GA 30033-6131
(404) 299-6488
(404) 299-7522
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
045331
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00818529E
—
GA
Enumeration date
07/18/2006
Last updated
01/18/2012
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