MEDICARE: GABRIELLA JUSTINE ROBERTS PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1306431820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA JUSTINE ROBERTS PA

Provider Business Mailing Address
First Line	:	2045 PEACHTREE RD NE STE 800
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1412
Country	:	US
Telephone Number	:	404-351-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 PEACHTREE RD NE STE 800
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1412
Country	:	US
Telephone Number	:	404-351-5711
Fax Number	:

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

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/07/2023

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