Healthcare Provider Details

I. General information

NPI: 1942087465
Provider Name (Legal Business Name): TAMHRA ROBERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4395 FULTON INDUSTRIAL BLVD SW STE D
ATLANTA GA
30336-1955
US

IV. Provider business mailing address

500 SAWGRASS VW
FAIRBURN GA
30213-2884
US

V. Phone/Fax

Practice location:
  • Phone: 404-500-0129
  • Fax: 470-729-7612
Mailing address:
  • Phone: 404-500-0129
  • Fax: 470-729-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: