Provider Demographics
NPI:1023042140
Name:ROBERSON, SANDRA K (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8200 ROBERTS DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4115
Mailing Address - Country:US
Mailing Address - Phone:770-952-8612
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:100 STONEFOREST DR STE 220
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4881
Practice Address - Country:US
Practice Address - Phone:770-953-3331
Practice Address - Fax:770-924-5890
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA34232207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00461084DMedicaid
E88104Medicare UPIN
GA00461084DMedicaid