Raven Rose, PA

NPI #1912693771 in Cumming, Georgia

Provider Information

NPI Number: 1912693771
Entity Type: Individual
Name: Raven Rose, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Apr 14, 2023
Last Updated: Apr 14, 2023

Practice Location

Address: 4150 DEPUTY BILL CANTRELL MEMORIAL RD
Address 2: SUITE #290
City: Cumming
State: Georgia
ZIP Code: 30040
Phone: (470) 719-1578

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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