Provider Demographics
NPI:1952580177
Name:NORTH ROSWELL INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:NORTH ROSWELL INTERNAL MEDICINE, PC
Other - Org Name:GOGA VUKOTIC, MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OGNJENKA
Authorized Official - Middle Name:GOGA
Authorized Official - Last Name:BRKIC-VUKOTIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-645-0017
Mailing Address - Street 1:11050 CRABAPPLE RD
Mailing Address - Street 2:BLDG. A STE 104-B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2489
Mailing Address - Country:US
Mailing Address - Phone:770-645-0017
Mailing Address - Fax:770-645-0024
Practice Address - Street 1:11050 CRABAPPLE RD
Practice Address - Street 2:BLDG. A STE 104-B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2489
Practice Address - Country:US
Practice Address - Phone:770-645-0017
Practice Address - Fax:770-645-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH06378Medicare UPIN
GA11BDWTXMedicare PIN