Provider Demographics
NPI:1780176891
Name:MICHAEL J ROSEN MD PLLC
Entity type:Organization
Organization Name:MICHAEL J ROSEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-450-0338
Mailing Address - Street 1:800 OLD ROSWELL LAKES PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8614
Mailing Address - Country:US
Mailing Address - Phone:404-450-0338
Mailing Address - Fax:631-824-9162
Practice Address - Street 1:800 OLD ROSWELL LAKES PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-8614
Practice Address - Country:US
Practice Address - Phone:404-450-0338
Practice Address - Fax:631-824-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA338862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty