MEDICARE: MISS ASHLEY JEAN ROBERTS MS, ATC

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	2255A2300X	Athletic Trainer	AT001227	GA

General Provider Information

NPI Number	:	1821015355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASHLEY JEAN ROBERTS MS, ATC

Provider Business Mailing Address
First Line	:	1022 RIVERBEND CLUB DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2802
Country	:	US
Telephone Number	:	770-980-1618
Fax Number	:

Provider Business Practice Location Address
First Line	:	1022 RIVERBEND CLUB DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2802
Country	:	US
Telephone Number	:	770-980-1618
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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