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General NPI Number Information
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NPI Number | 1063694412
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Entity Type | Organization
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Legal Business Name | JOHN D ROBERTS MDPC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 917 PLAZA AVE
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City | EASTMAN
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State | GA
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Zip | 31023-6759
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Country | US
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Telephone | 478-374-9767
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Fax | 478-374-9769
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Provider Business Mailing Address
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Address Line | 917 PLAZA AVE
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City | EASTMAN
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State | GA
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Zip | 31023-6759
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Country | US
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Telephone | 478-374-9767
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Fax | 478-374-9769
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Authorized Official
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Title or Position | MANAGER
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Name | JENNIFER A ROBERTS
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Credential |
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Telephone | 478-374-9767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 047253
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License Number State | GA
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