Provider Demographics
NPI:1245299668
Name:ROOS, JULIA K (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:K
Last Name:ROOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:520 N DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4188
Practice Address - Country:US
Practice Address - Phone:704-484-8001
Practice Address - Fax:704-484-2485
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21868207Q00000X
NC200200590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01131300OtherRAILROAD MEDICARE
NC89131XAMedicaid
SCAA7340J577OtherMEDICARE PIN
SCL33998Medicaid
SCL33998Medicaid
SCAA73406121Medicare PIN