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General NPI Number Information
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NPI Number | 1922112606
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Entity Type | Individual
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Provider Name | JAMES REID ROBERTS III D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 1125 COMMERCE DR STE 100 SUITE A
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3575
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Country | US
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Telephone | 770-486-8516
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Fax | 770-818-5547
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Provider Business Mailing Address
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Address Line | 1125 COMMERCE DR STE 100
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3575
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Country | US
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Telephone | 770-486-8516
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Fax | 770-818-5547
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN012947
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License Number State | GA
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