Gina W Roberts | |
146 S Tallahassee St Hazlehurst GA 31539-6457 | |
(912) 375-4531 | |
(912) 375-4532 |
Full Name | Gina W Roberts |
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Speciality | Dentist - General Practice |
Location | 146 S Tallahassee St, Hazlehurst, Georgia |
Authorized Official Name and Position | Gina W Roberts (OWNER) |
Authorized Official Contact | 9123754531 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Gina W Roberts Po Box 1300 Hazlehurst GA 31539-1300 Ph: (912) 375-4531 | Gina W Roberts 146 S Tallahassee St Hazlehurst GA 31539-6457 Ph: (912) 375-4531 |
NPI Number | 1962675397 |
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Provider Enumeration Date | 04/07/2008 |
Last Update Date | 04/07/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962675397 | NPI | - | NPPES |
1861601882 | Other | INDIVIDUAL NPI | |
00386636B | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 10748 (Georgia) | Primary |