MEDICARE: DR. TAMI CARBY ROBERTSON O.D.

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	152W00000X	Optometrist	7349T	TX
2	152W00000X	Optometrist	OPT 002651	GA

General Provider Information

NPI Number	:	1982838975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMI CARBY ROBERTSON O.D.

Provider Business Mailing Address
First Line	:	400 BARRETT PKWY STE 158
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-4952
Country	:	US
Telephone Number	:	770-429-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	3155 COBB PKWY SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5535
Country	:	US
Telephone Number	:	770-644-0012
Fax Number	:	770-644-0091

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

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	02/16/2018

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