Provider Demographics
NPI:1982047189
Name:LIPIN, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:LIPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:STE 260
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-0000
Mailing Address - Country:US
Mailing Address - Phone:770-292-3045
Mailing Address - Fax:770-292-3046
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Practice Address - Street 2:STE 260
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-0000
Practice Address - Country:US
Practice Address - Phone:770-292-3045
Practice Address - Fax:770-292-3046
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA82725207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program