Healthcare Provider Details

I. General information

NPI: 1326367483
Provider Name (Legal Business Name): TIFFANY K ROBERTS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY K ROBERTS WILSON PHD

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GREAT BRIDGE BLVD SUITE B
CHESAPEAKE VA
23320-7008
US

IV. Provider business mailing address

317 GREAT BRIDGE BLVD SUITE B
CHESAPEAKE VA
23320-7008
US

V. Phone/Fax

Practice location:
  • Phone: 404-561-5988
  • Fax:
Mailing address:
  • Phone: 404-561-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: