Provider Demographics
NPI:1326070939
Name:ROME INTERNAL MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:ROME INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-295-3961
Mailing Address - Street 1:123 THREE RIVERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-2300
Mailing Address - Country:US
Mailing Address - Phone:706-295-3961
Mailing Address - Fax:706-295-3979
Practice Address - Street 1:123 THREE RIVERS DR NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2300
Practice Address - Country:US
Practice Address - Phone:706-295-3961
Practice Address - Fax:706-295-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP475Medicare ID - Type Unspecified