Provider Demographics
NPI:1700155959
Name:OFFOHA, ROOSEVELT (MD)
Entity Type:Individual
Prefix:
First Name:ROOSEVELT
Middle Name:
Last Name:OFFOHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1700 TREE LN STE 300
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6747
Practice Address - Country:US
Practice Address - Phone:678-205-4299
Practice Address - Fax:678-214-6112
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97700207X00000X
TXS2443207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery