Active NPI
Lisa Sue Rosof, M.D.
- Psychiatry Physician
- Atlanta, GA
National Provider Identifier
1194000794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 44325
- Practice address
- 675 Seminole Ave NE
Suite 110
Atlanta, GA 30307-3408 - Phone
- (404) 817-0511
- NPI assigned
- Oct 14, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 44325 | GA | Primary |
Addresses
Primary practice location
675 Seminole Ave NE
Suite 110
Atlanta, GA 30307-3408
Mailing address
675 Seminole Ave NE
Suite 110
Atlanta, GA 30307-3408
Phone (404) 817-0511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 2, 2022 through Mar 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44325 | GA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318550400000",
"number": "1194000794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 SEMINOLE AVE NE",
"address_2": "SUITE 110",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303073408",
"telephone_number": "404-817-0511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 SEMINOLE AVE NE",
"address_2": "SUITE 110",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303073408",
"telephone_number": "404-817-0511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSOF",
"first_name": "LISA",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-14",
"last_updated": "2011-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "44325",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.