Provider Demographics
NPI:1033128004
Name:ROBERTS, LORI G (CPNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:G
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4706
Mailing Address - Country:US
Mailing Address - Phone:678-527-6000
Mailing Address - Fax:770-822-1573
Practice Address - Street 1:3815 HARRISON RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2462
Practice Address - Country:US
Practice Address - Phone:678-527-6000
Practice Address - Fax:770-466-6201
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN070413363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics