Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 34232 | GA |
NPI | 1023042140 |
---|---|
Provider Name | Sandra K Roberson |
First Address | Sandy Springs, GA 30350-4115 |
Second Address | Woodstock, GA 30189-4881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00461084D | (05) | GA |
E88104 | (02) |