Provider Demographics
NPI:1568085157
Name:DEVANTIER, ROSS W
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:W
Last Name:DEVANTIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 WOODCHASE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2052
Mailing Address - Country:US
Mailing Address - Phone:678-956-1272
Mailing Address - Fax:
Practice Address - Street 1:403 WOODCHASE WAY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2052
Practice Address - Country:US
Practice Address - Phone:678-956-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant