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General NPI Number Information
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NPI Number | 1568632081
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Entity Type | Individual
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Provider Name | DANIELLE L ROBERTS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 340 KENNESTONE HOSPITAL BLVD SUITE 200
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City | MARIETTA
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State | GA
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Zip | 30060-1152
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Country | US
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Telephone | 770-281-5100
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Fax | 678-581-7100
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Provider Business Mailing Address
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Address Line | 1700 HOSPITAL SOUTH DR SUITE 300
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City | AUSTELL
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State | GA
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Zip | 30106-6810
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Country | US
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Telephone | 770-944-2830
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Fax | 678-581-7170
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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 | 005285
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License Number State | GA
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