Provider Demographics
NPI:1952395550
Name:BRIGLEVICH, ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:BRIGLEVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3969 S COBB DR SE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6358
Mailing Address - Country:US
Mailing Address - Phone:770-433-0434
Mailing Address - Fax:770-433-0435
Practice Address - Street 1:3969 S COBB DR SE
Practice Address - Street 2:SUITE 107
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:770-433-0434
Practice Address - Fax:770-433-0435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA017042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine