Provider Demographics
NPI:1407955842
Name:ROSS, JOHN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3915 CASCADE RD SW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8512
Mailing Address - Country:US
Mailing Address - Phone:404-696-1944
Mailing Address - Fax:404-696-5705
Practice Address - Street 1:3915 CASCADE RD SW
Practice Address - Street 2:SUITE 310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:404-696-1944
Practice Address - Fax:404-696-5705
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000235331FMedicaid
GA000235331AMedicaid
GA000235331FMedicaid