=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528784881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAECY C ROBERTSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2022
-----------------------------------------------------
Last Update Date | 11/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11116 MEDICAL CAMPUS RD
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21742-6710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-977-2699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1520 CLIFTON RD NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WX0003X
-----------------------------------------------------
Taxonomy Name | Inpatient Obstetric Registered Nurse
-----------------------------------------------------
License Number | RN306647
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------