Provider Demographics
NPI:1063438745
Name:ROSE, JANA M (DPM)
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-1002
Mailing Address - Country:US
Mailing Address - Phone:706-776-3132
Mailing Address - Fax:706-776-2836
Practice Address - Street 1:134B MARKET CORNERS DR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5766
Practice Address - Country:US
Practice Address - Phone:706-776-3132
Practice Address - Fax:706-776-2836
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000902213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00631297OtherRAILROAD MEDICARE
GA00871934CMedicaid
48SCCKVMedicare ID - Type Unspecified
4624980001Medicare NSC
GAP00631297OtherRAILROAD MEDICARE