Provider Demographics
NPI:1114180155
Name:ROBATEAU, AYANA C (OD)
Entity Type:Individual
Prefix:DR
First Name:AYANA
Middle Name:C
Last Name:ROBATEAU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 ESPLANADE CIR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-4221
Mailing Address - Country:US
Mailing Address - Phone:770-960-2020
Mailing Address - Fax:770-968-0854
Practice Address - Street 1:3176 ESPLANADE CIR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-4221
Practice Address - Country:US
Practice Address - Phone:770-960-2020
Practice Address - Fax:770-968-0854
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA669551517ACMedicaid