Healthcare Provider Details

I. General information

NPI: 1639810088
Provider Name (Legal Business Name): TAWANNA CHARLTON-ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1024 SW 7TH AVE APT 108
GAINESVILLE FL
32601-1345
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-1745
  • Fax:
Mailing address:
  • Phone: 850-508-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number111928
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: