Healthcare Provider Details

I. General information

NPI: 1477739837
Provider Name (Legal Business Name): JESSICA LEA GRIFFIN ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JUNIOR DR. SE
ATLANTA GA
30303
US

IV. Provider business mailing address

49 JESSE HILL JUNIOR DR.
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1440
  • Fax: 404-778-1401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number002849
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: