Roth, Jeffrey Ira
Roth, Jeffrey Ira is an individual health care provider with primary practice located at 4385 Johns Creek Pkwy Ste 250, Suwanee GA 30024-6048. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Pediatric Otolaryngology, Allopathic & Osteopathic Physicians / Otolaryngic Allergy. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Roth, Jeffrey Ira can be contacted via phone (770) 623-1608.Contact Information
Primary practice address
4385 Johns Creek Pkwy Ste 250
Suwanee GA 30024-6048
Phone: (770) 623-1608
Fax: (678) 992-2540
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 041654 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Otolaryngology | 207YP0228X | 041654 | Georgia |
| Allopathic & Osteopathic Physicians / Otolaryngic Allergy | 207YX0602X | 041654 | Georgia |
Profile Details
| NPI number | 1417945320 |
|---|---|
| LBN Legal business name | Roth, Jeffrey Ira |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2005 |
| Last updated | Dec 18th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417945320 | NPPES |
| Georgia | MEDICAID | 000714381M | |
| Georgia | MEDICAID | 000714381J |
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