Provider Demographics
NPI:1700975299
Name:ROHR, BRAD L (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:L
Last Name:ROHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 JOHNSON FERRY PL
Mailing Address - Street 2:SUITE A-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2048
Mailing Address - Country:US
Mailing Address - Phone:678-560-0511
Mailing Address - Fax:678-560-0739
Practice Address - Street 1:1230 JOHNSON FERRY PL
Practice Address - Street 2:SUITE A-10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:678-560-0511
Practice Address - Fax:678-560-0739
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08CBCBVMedicare PIN
GAG05407Medicare UPIN