Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 69945 | GA |
NPI | 1215199203 |
---|---|
Provider Name | Dr. Danice B Roberts |
First Address | Albany, GA 31701-1572 |
Second Address | Albany, GA 31701-1572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 22/08/2013 |