Healthcare Provider Details

I. General information

NPI: 1528986171
Provider Name (Legal Business Name): COURAGE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1996 DERRICK DR
GRAYSON GA
30017-2208
US

IV. Provider business mailing address

1996 DERRICK DR
GRAYSON GA
30017-2208
US

V. Phone/Fax

Practice location:
  • Phone: 404-402-8564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN291921
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: