Provider Demographics
NPI:1295257731
Name:ROORBACH, MADELINE DALTON
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:DALTON
Last Name:ROORBACH
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 1:2665 N DECATUR RD STE 130
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6136
Mailing Address - Country:US
Mailing Address - Phone:404-501-7081
Mailing Address - Fax:404-501-1085
Practice Address - Street 1:2665 N DECATUR RD STE 130
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6136
Practice Address - Country:US
Practice Address - Phone:404-501-7081
Practice Address - Fax:404-501-1085
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery