DEMETRIUS ROMAN (NPI# 1811474125) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811474125 |
| Entity Type | Individual |
| Full Name | DEMETRIUS ROMAN |
| Practice Address |
1580 Phoenix Blvd Ste 200 Atlanta GA 30349-5187 |
| Mailing Address |
Po Box 962651 Riverdale GA 30296-6926 |
| Practice Telephone | 7702820389 |
| Mailing Telephone | 7702820389 |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TF0000X |
Psychologist Specialization: Family |
06211979 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00320566A | 05 |
| Street Address |
1580 PHOENIX BLVD STE 200 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30349-5187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376185686 | Kmb Diagnostics | Durable Medical Equipment & Medical Supplies | 941 Flat Shoals Rd, Atlanta, GA 30349 | 2019-10-09 |
| 1114575859 | Justin Vassell | Registered Nurse | 1903 Phoenix Boulevard, Suite 200, College Park, GA 30349 | 2019-08-27 |
| 1841856663 | Kennyetta Danielle Watkins | Counselor | 1431 Riverwalk Ln, Apt. F, College Park, GA 30349 | 2019-05-16 |
| 1275002636 | Patriot Healthcare of Georgia, LLC | Family Medicine | 1587 Phoenix Boulevard, Suite 6, College Park, GA 30349 | 2018-11-15 |
| 1669971875 | Ee Consulting Solution | Case Management | 6320 Topaz Tral, Arlanta, GA 30349 | 2018-02-03 |
| 1629595640 | Shayla Bouie | Contractor | 5420 Riverdale Rd Apt D17, Atlanta, GA 30349 | 2017-08-30 |
| 1114475563 | Jasmine V Mccully | Social Worker | 5864 Summergien Lane, College Park, GA 30349 | 2016-09-14 |
| 1639537681 | Shelia Thornton | Counselor | 5856 Seabright Lane, Atlanta, GA 30349 | 2016-02-05 |
| 1346610177 | Joanne Resilard | Nurse Practitioner | 2931 Herron Ln Sw, Atlanta, GA 30349 | 2015-10-06 |
| 1063805091 | Southwest Atlanta Medical & Rehabilitation Clinic LLC | Family Medicine | 495 85 Circle, Suite 100, Atlanta, GA 30349 | 2015-03-16 |
| Find all providers in zip 30349 | ||||
| Taxonomy Code | 103TF0000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184847212 | Gloria Desantis Meaux | Psychologist | 18 Lenox Pointe Ne # B, Atlanta, GA 30324-3168 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982733713 | Fred D Fraser | Psychologist | 11755 Pointe Pl, Roswell, GA 30076-4636 | 2007-03-05 |
Please comment or provide details below to improve the information on DEMETRIUS ROMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.