Wellborn, Roger Gary
Wellborn, Roger Gary is an individual health care provider with primary practice located at 624 Dixie Street , Carrollton GA 30117-3817. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wellborn, Roger Gary can be contacted via phone (770) 832-9593.Contact Information
Primary practice address
624 Dixie Street
Carrollton GA 30117-3817
Phone: (770) 832-9593
Fax: (770) 832-0440
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 21441 | Georgia |
Profile Details
| NPI number | 1417051152 |
|---|---|
| LBN Legal business name | Wellborn, Roger Gary |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 12th, 2006 |
| Last updated | Feb 2nd, 2012 - about 14 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 | 1417051152 | NPPES |
| Georgia | MEDICAID | 00260202A |
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