Provider Demographics
NPI:1417746603
Name:MCLEOD, ROSEMARIE
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 AVALON PKWY STE 345
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3054
Mailing Address - Country:US
Mailing Address - Phone:347-303-9452
Mailing Address - Fax:
Practice Address - Street 1:2020 AVALON PKWY STE 345
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3054
Practice Address - Country:US
Practice Address - Phone:347-303-9452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21094096163WC1500X, 164W00000X, 174200000X, 251S00000X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No174200000XOther Service ProvidersMeals
No251S00000XAgenciesCommunity/Behavioral Health