1225210925 NPI number — ROZA K ADAMCZYK MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225210925 NPI number — ROZA K ADAMCZYK MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROZA K ADAMCZYK MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225210925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
618 S 8TH ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRIFFIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30224-4251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-227-1102
Provider Business Mailing Address Fax Number:
770-227-3082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 GOVERNORS SQ
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30215-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-486-8065
Provider Business Practice Location Address Fax Number:
770-227-3082
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARONSON
Authorized Official First Name:
LUBA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
770-227-1102

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  029568 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21003404108 . This is a "BEECHSTREET" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 328469 . This is a "WELLCARE - MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00347234G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4567388 . This is a "AETNA- PPO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52239078001 . This is a "BLUE CROSS BLUE SHILE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52239078002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00347234B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1020061 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2339303 . This is a "AETNA - HMO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11363 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10058864 . This is a "AMERIGROUP - MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 117715 . This is a "PEACHSTATE - MCAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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