Organization
GINA W ROBERTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA W ROBERTS DDS (OWNER)
(912) 375-4531
Entity
Organization
Contact information
Practice address
146 S TALLAHASSEE ST, HAZLEHURST, GA 31539-6457
(912) 375-4531
(912) 375-4532
Mailing address
PO BOX 1300, HAZLEHURST, GA 31539-1300
(912) 375-4531
(912) 375-4532
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10748
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00386636B
—
GA
01
—
1861601882
INDIVIDUAL NPI
—
Enumeration date
04/07/2008
Last updated
04/07/2008
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