=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972558328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATRINA L ROBERSON-TRAMMELL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8010 MOFFETT RD
-----------------------------------------------------
City | SEMMES
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36575-5406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-645-8946
-----------------------------------------------------
Fax | 251-645-8976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 36258
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-318-2678
-----------------------------------------------------
Fax | 251-405-9900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 19407
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------