Provider Demographics
NPI:1720368814
Name:ROPHE MEDICS CLINIC
Entity Type:Organization
Organization Name:ROPHE MEDICS CLINIC
Other - Org Name:ROPHE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AFOLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBOLAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-309-9977
Mailing Address - Street 1:3001 SOUTH COBB DRIVE
Mailing Address - Street 2:SIUTE 205
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:678-309-9977
Mailing Address - Fax:678-309-9973
Practice Address - Street 1:3001 SOUTH COBB DRIVE
Practice Address - Street 2:SIUTE 205
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:678-309-9977
Practice Address - Fax:678-309-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20270G7509OtherMEDICARE PTAN