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General NPI Number Information
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NPI Number | 1285818567
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Entity Type | Individual
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Provider Name | NATISHA LATRISE ROBERSON-DUNN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/22/2007
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Last Update Date | 12/22/2007
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Provider Practice Location Address
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Address Line | 195 FAIRVIEW RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-2722
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Country | US
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Telephone | 770-507-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 15 COBBLESTONE DR
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City | NEWNAN
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State | GA
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Zip | 30265-6047
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Country | US
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Telephone | 770-304-3932
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004412
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License Number State | GA
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