Provider Demographics
NPI:1326226861
Name:MANCE, ROSALIND M (MD, MBBS)
Entity Type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:M
Last Name:MANCE
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Gender:F
Credentials:MD, MBBS
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Mailing Address - Street 1:1428 BENNING PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1624
Mailing Address - Country:US
Mailing Address - Phone:404-577-9082
Mailing Address - Fax:404-577-1828
Practice Address - Street 1:150 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2543
Practice Address - Country:US
Practice Address - Phone:404-577-9082
Practice Address - Fax:404-577-1828
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA220952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00296986AMedicaid
GAFM2081519OtherDEA REGISTRATION
GAD40533Medicare UPIN