Individual
DEMETRIUS ROMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1580 PHOENIX BLVD STE 200, ATLANTA, GA 30349-5187
(770) 282-0389
Mailing address
PO BOX 962651, RIVERDALE, GA 30296-6926
(770) 282-0389
Taxonomy
Speciality
Code
Description
License number
State
103TF0000X
Family Psychologist
Primary
06211979
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00320566A
—
GA
Enumeration date
07/19/2018
Last updated
07/19/2018
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