Individual
RAVEN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4150 DEPUTY BILL CANTRELL MEMORIAL RD, SUITE #290, CUMMING, GA 30040
(470) 719-1578
Mailing address
5798 OGEECHEE RD APT 833, SAVANNAH, GA 31405-9542
(404) 645-4993
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
GA
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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