Provider Demographics
NPI:1083866743
Name:ROSE, JAMES E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:ROSE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4861 BILL GARDNER PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3644
Mailing Address - Country:US
Mailing Address - Phone:770-626-5740
Mailing Address - Fax:770-626-5750
Practice Address - Street 1:4861 BILL GARDNER PKWY
Practice Address - Street 2:STE 100
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3644
Practice Address - Country:US
Practice Address - Phone:770-626-5740
Practice Address - Fax:770-626-5750
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2015-05-21
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Provider Licenses
StateLicense IDTaxonomies
GA003570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant