Rosa L Borden
Individual provider Active NPI Contractor · Vienna, GA
NPI 1497311401 · NPPES record last updated May 15, 2019
Key facts
- NPI
- 1497311401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 051413705 (GA)
- Practice address
- 607 S 5TH St
Vienna, GA 31092-1529 - Phone
- (478) 244-4351
- NPI assigned
- May 15, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051413705 | GA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 051413705 | GA | Yes |
Addresses
Primary practice location
607 S 5TH St
Vienna, GA 31092-1529
Mailing address
607 S 5TH St
Vienna, GA 31092-1529
Phone (478) 244-4351
Other providers in Vienna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.