Provider Demographics
NPI:1508931171
Name:ROLLINS, CHESTER PALMOUR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:PALMOUR
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2449
Mailing Address - Country:US
Mailing Address - Phone:404-351-5045
Mailing Address - Fax:404-897-7078
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-351-5045
Practice Address - Fax:404-351-0883
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA027114207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA040005117OtherRAILROAD MEDICARE
GA581203597OtherEIN
GAGRP861Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
GA581203597OtherEIN