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General NPI Number Information
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NPI Number | 1144677428
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Entity Type | Individual
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Provider Name | MS. TASHA MONIQUE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 1830 WATER PL. SE STE 295
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City | ATLANTA
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State | GA
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Zip | 30339
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Country | US
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Telephone | 770-575-3644
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Fax | 770-575-3641
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Provider Business Mailing Address
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Address Line | 1830 WATER PLACE SE STE #295
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City | ATLANTA
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State | GA
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Zip | 30339
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Country | US
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Telephone | 770-575-3644
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Fax | 770-575-3641
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | FTR2025051
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License Number State | GA
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