=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891903894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO ATLANTA WOMENS HEALTH SPECIALIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5462 MEMORIAL DR SUITE 102
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-508-8133
-----------------------------------------------------
Fax | 404-508-8450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5462 MEMORIAL DR SUITE 102
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-508-8133
-----------------------------------------------------
Fax | 404-508-8450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES ROBERTS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 404-508-8133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 032282
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------