Individual
MRS. DIANNE ROBERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3421 MIKE PADGETT HWY, AUGUSTA, GA 30906-3815
(706) 432-7893
(706) 432-3780
Mailing address
3503 CARIBBEAN CT, AUGUSTA, GA 30906-5104
(706) 432-7893
(706) 432-3780
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606317B
—
GA
Enumeration date
03/28/2012
Last updated
03/28/2012
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