Provider Demographics
NPI:1437219375
Name:ROSS, DEBORAH PERRY
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:PERRY
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WOODSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6223
Mailing Address - Country:US
Mailing Address - Phone:678-432-8645
Mailing Address - Fax:678-432-8649
Practice Address - Street 1:72 WOODSTOWN RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-6223
Practice Address - Country:US
Practice Address - Phone:678-432-8645
Practice Address - Fax:678-432-8649
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator