Doctor Name: | MRS. NATISHA LATRISE ROBERSON-DUNN |
NPI Number: | 1285818567 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 004412 |
Business Practice Address: | 195 Fairview Rd Ellenwood, GA - 302942722 |
Business Phone Number: | 7705070112 |
Business Fax Number: | |
Mailing Address: | 15 Cobblestone Dr, NEWNAN |
State: | GA |
Postal Code: | 302656047 |
Phone Number: | 7703043932 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2007 |
NPI Last Update Date: | 12/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004412 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |