Provider Demographics
NPI:1427130301
Name:ROSWELL INTERNAL MEDICINE SPECIALISTS PC
Entity type:Organization
Organization Name:ROSWELL INTERNAL MEDICINE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZURINAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-393-0012
Mailing Address - Street 1:4050 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6459
Mailing Address - Country:US
Mailing Address - Phone:770-645-8295
Mailing Address - Fax:
Practice Address - Street 1:11785 NORTHFALL LN
Practice Address - Street 2:SUITE 505
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7971
Practice Address - Country:US
Practice Address - Phone:678-393-0012
Practice Address - Fax:678-393-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13530Medicare UPIN
GA11BDSZJMedicare ID - Type Unspecified