Provider Demographics
NPI:1770909236
Name:ROMULUS, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ROMULUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1839
Mailing Address - Country:US
Mailing Address - Phone:770-675-7407
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR
Practice Address - Street 2:BLDG 2 STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-250-1204
Practice Address - Fax:404-250-1205
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183825163W00000X, 163WG0000X, 163WP0809X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult