Provider Demographics
NPI:1003005000
Name:THE ROSS ORTHOPAEDIC WELLNESS CENTER
Entity Type:Organization
Organization Name:THE ROSS ORTHOPAEDIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:678-405-3252
Mailing Address - Street 1:5900 HILLANDALE DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3802
Mailing Address - Country:US
Mailing Address - Phone:678-405-3252
Mailing Address - Fax:770-234-5103
Practice Address - Street 1:5900 HILLANDALE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3802
Practice Address - Country:US
Practice Address - Phone:678-405-3252
Practice Address - Fax:770-234-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047650207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty