MEDICARE: DANIEL S ROBERSON PA-C

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	363AS0400X	Surgical Physician Assistant	7920	GA

General Provider Information

NPI Number	:	1780044610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL S ROBERSON PA-C

Provider Business Mailing Address
First Line	:	1551 JANMAR RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5606
Country	:	US
Telephone Number	:	470-579-5600
Fax Number	:	229-436-4107

Provider Business Practice Location Address
First Line	:	1371 CHURCH STREET EXT NE STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7913
Country	:	US
Telephone Number	:	678-344-8900
Fax Number	:	678-666-5201

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

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	05/24/2024

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