Provider Demographics
NPI:1740259563
Name:ROSEN, SETH ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:ALAN
Last Name:ROSEN
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 1:6335 HOSPITAL PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1550
Mailing Address - Country:US
Mailing Address - Phone:404-778-3307
Mailing Address - Fax:770-813-4654
Practice Address - Street 1:6335 HOSPITAL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1550
Practice Address - Country:US
Practice Address - Phone:404-778-3307
Practice Address - Fax:770-813-4654
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051269208C00000X
GA51269208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00944842AMedicaid
GAH56977Medicare UPIN
GA00944842AMedicaid
GA28BBBCHMedicare PIN
28BBBCHMedicare UPIN