Provider Demographics
NPI:1225354525
Name:ROSSI, FLAVIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:FLAVIA
Middle Name:S
Last Name:ROSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 18TH ST E
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3643
Mailing Address - Country:US
Mailing Address - Phone:229-353-7337
Mailing Address - Fax:
Practice Address - Street 1:39 KENT RD
Practice Address - Street 2:SUITE 5
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1698
Practice Address - Country:US
Practice Address - Phone:229-353-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA069623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134188AMedicaid