Provider Demographics
NPI:1841580099
Name:ROLAND, CYNTHIA S
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:ROLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7500
Mailing Address - Country:US
Mailing Address - Phone:478-633-0404
Mailing Address - Fax:478-633-0805
Practice Address - Street 1:840 PINE ST STE 990
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7500
Practice Address - Country:US
Practice Address - Phone:478-633-0404
Practice Address - Fax:478-633-0805
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA080392207V00000X
390200000X
GA80392207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program