Provider Demographics
NPI:1639981145
Name:ROLLE, ANDRE CORNELIUS SR
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:CORNELIUS
Last Name:ROLLE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 MILLER RUN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7915
Mailing Address - Country:US
Mailing Address - Phone:770-843-3350
Mailing Address - Fax:
Practice Address - Street 1:772 MILLER RUN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-7915
Practice Address - Country:US
Practice Address - Phone:770-843-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health