| Gina W Roberts | |
|
146 S Tallahassee St Hazlehurst GA 31539-6457 | |
| (912) 375-4531 | |
| (912) 375-4532 |
| Full Name | Gina W Roberts |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |