Organization
JOHNS CREEK FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES L ROTH MD (MEMBER)
(678) 474-0040
Entity
Organization
Contact information
Practice address
4365 JOHNS CREEK PKWY, SUITE 430, SUWANEE, GA 30024-6089
(678) 474-0040
(678) 474-0095
Mailing address
4365 JOHNS CREEK PKWY, SUITE 430, SUWANEE, GA 30024-6089
(678) 474-0040
(678) 474-0095
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046525
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000971308A
—
GA
01
—
DB1574
RAILROAD MEDICARE GROUP
—
01
—
GRP4691
MEDICARE GROUP NUMBER
—
Enumeration date
09/05/2007
Last updated
10/15/2012
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