Provider Demographics
NPI:1912993452
Name:SPILLANE, ROSEMARIE (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 NOAH DR # 113-315
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-8705
Mailing Address - Country:US
Mailing Address - Phone:706-301-1098
Mailing Address - Fax:706-301-9151
Practice Address - Street 1:1266 HIGHWAY 515 S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4872
Practice Address - Country:US
Practice Address - Phone:706-692-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037702207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA364065OtherBCBS OF GEORGIA
GAP99931054OtherRR MEDICARE PROVIDER NUM
GA000577123KMedicaid
GA000577123IMedicaid
GA364065OtherBCBS OF GEORGIA
GAP99931054OtherRR MEDICARE PROVIDER NUM