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General NPI Number Information
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NPI Number | 1851785885
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Entity Type | Individual
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Provider Name | HENRY EARL ROBERSON
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Gender | Male
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 140 8TH ST
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City | AUGUSTA
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State | GA
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Zip | 30901-1310
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Country | US
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Telephone | 770-944-7280
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Fax | 770-944-9518
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Provider Business Mailing Address
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Address Line | PO BOX 1821
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City | MABLETON
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State | GA
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Zip | 30126-1013
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Country | US
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Telephone | 770-944-7280
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Fax | 770-944-9518
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW001776
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License Number State | GA
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