Provider Demographics
NPI:1790028553
Name:ROSE, ALLISON THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:THOMAS
Last Name:ROSE
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 1:212 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4851
Mailing Address - Country:US
Mailing Address - Phone:404-791-9624
Mailing Address - Fax:
Practice Address - Street 1:2015 UPPERGATE DRIVE DIVISION OF NEONATOLOGY 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-3049
Practice Address - Country:US
Practice Address - Phone:404-727-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75506208000000X
GA0755062080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics