Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN070413 | GA |
NPI | 1033128004 |
---|---|
Provider Name | Lori G Roberts |
First Address | Lawrenceville, GA 30045-4706 |
Second Address | Loganville, GA 30052-2462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |