Provider Demographics
NPI:1225210925
Name:ROZA K ADAMCZYK MD PC
Entity Type:Organization
Organization Name:ROZA K ADAMCZYK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUBA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-227-1102
Mailing Address - Street 1:618 S 8TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4251
Mailing Address - Country:US
Mailing Address - Phone:770-227-1102
Mailing Address - Fax:770-227-3082
Practice Address - Street 1:106 GOVERNORS SQ
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4805
Practice Address - Country:US
Practice Address - Phone:770-486-8065
Practice Address - Fax:770-227-3082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROZA K ADAMCZYK MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0295682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA21003404108OtherBEECHSTREET
GA328469OtherWELLCARE - MEDICAID
GA00347234GMedicaid
GA4567388OtherAETNA- PPO
GA52239078001OtherBLUE CROSS BLUE SHILE
GA52239078002OtherBLUE CROSS BLUE SHIELD
GA00347234BMedicaid
GA1020061OtherCIGNA
GA2339303OtherAETNA - HMO
GA11363OtherUNITED HEALTHCARE
GA10058864OtherAMERIGROUP - MEDICAID
GA117715OtherPEACHSTATE - MCAID
GA13BDDFVMedicare PIN
GA52239078001OtherBLUE CROSS BLUE SHILE
GA13BDDFV01Medicare PIN