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NPI Code Detail

MEDICARE: ROBERT M ROBERSON III CRNA

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
1367500000XCertified Registered Nurse AnesthetistRN107179GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00352151OTHERGARR MEDICARE INDIVIDUAL

Other Identifiers

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