| Organization Name: | WARLITO G ROLLOLAZO |
| NPI Number: | 1851419410 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WARLITO G ROLLOLAZO (OWNER) |
| Mailing Address: | 809 W Bankhead Hwy Suite D Villa Rica |
| State: | GA US |
| Postal Code: | 301801520 |
| Phone Number: | 7704569993 |
| Fax Number: | 7704569949 |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 06/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 17551 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |