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NPI Code Detail

MEDICARE: CARNELL DURREL ROBERTS JR.

MEDICARE: CARNELL DURREL ROBERTS JR.
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
1235Z00000XSpeech-Language PathologistPCET001966GA

General Provider Information

NPI Number : 1730515875
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARNELL DURREL ROBERTS JR.
Provider Business Mailing Address
First Line : PO BOX 572
Second Line :
City : WARM SPRINGS
State : GA
Zip : 31830-0572
Country : US
Telephone Number : 706-741-0840
Fax Number :
Provider Business Practice Location Address
First Line : 6135 ROOSEVELT HWY
Second Line :
City : WARM SPRINGS
State : GA
Zip : 31830-2757
Country : US
Telephone Number : 706-655-5432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2013
Last Update Date : 09/20/2013

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Directions to “ CARNELL DURREL ROBERTS JR. ” Practice Location

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