Provider Demographics
NPI:1821720897
Name:ROSE, ESSENCE SHREE (CNA/CMA)
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:SHREE
Last Name:ROSE
Suffix:
Gender:F
Credentials:CNA/CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 DALLAS HWY LOT C18
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5719
Mailing Address - Country:US
Mailing Address - Phone:404-488-6646
Mailing Address - Fax:
Practice Address - Street 1:7631 DALLAS HWY LOT C18
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5719
Practice Address - Country:US
Practice Address - Phone:404-488-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014210569376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide