Provider Demographics
NPI:1033227202
Name:ROBERSON, CHARLES ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDERSON
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:770-792-5451
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL DR STE 707
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4130
Practice Address - Country:US
Practice Address - Phone:706-880-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38947174400000X
WAMD00042553207X00000X
GA87226207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38947OtherTENNESSEE MEDICAL LICENSE
WAMD00042553OtherWASHINGTON MEDICAL LICENS
OH35.086840OtherOHIO MEDICAL LICENSE
H88622Medicare UPIN