MEDICARE: ROBERT M ROBERSON III CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN107179	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00352151	OTHER	GA	RR MEDICARE INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194792390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M ROBERSON III CRNA

Provider Business Mailing Address
First Line	:	PO BOX 18824
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27419-8824
Country	:	US
Telephone Number	:	336-553-1659
Fax Number	:	336-553-3994

Provider Business Practice Location Address
First Line	:	247 S MAIN ST
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-4605
Country	:	US
Telephone Number	:	912-557-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	05/13/2025

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