Basic Information
Provider Information
NPI: 1881057297
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSEBERRY
FirstName: HANNAH
MiddleName: ZUCKER
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 658
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305030658
CountryCode: US
TelephoneNumber: 7705336519
FaxNumber:  
Practice Location
Address1: 725 JESSE JEWELL PKWY SE
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305013834
CountryCode: US
TelephoneNumber: 7702972200
FaxNumber: 7705348139
Other Information
ProviderEnumerationDate: 04/01/2016
LastUpdateDate: 07/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000XMD24458MEY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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