Provider Demographics
NPI:1629276589
Name:PHILEN, ROSSANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSSANNE
Middle Name:M
Last Name:PHILEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 HAWTHORNE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1367
Mailing Address - Country:US
Mailing Address - Phone:404-457-3252
Mailing Address - Fax:
Practice Address - Street 1:2801 HAWTHORNE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1367
Practice Address - Country:US
Practice Address - Phone:404-457-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024061208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice