Healthcare Provider Details

I. General information

NPI: 1285295618
Provider Name (Legal Business Name): MARSHA A WARD ROBERTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 WATSON BLVD
WARNER ROBINS GA
31093-3631
US

IV. Provider business mailing address

114 SWEETWATER DR
LIZELLA GA
31052-3518
US

V. Phone/Fax

Practice location:
  • Phone: 478-225-2811
  • Fax:
Mailing address:
  • Phone: 478-390-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN213794
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN213794
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: