Provider Demographics
NPI:1215199203
Name:ROBERTS, DANICE B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANICE
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1572
Mailing Address - Country:US
Mailing Address - Phone:229-434-1400
Mailing Address - Fax:229-434-0040
Practice Address - Street 1:1801 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1572
Practice Address - Country:US
Practice Address - Phone:229-434-1400
Practice Address - Fax:229-434-0040
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA699452080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270532Medicare PIN
IL6447860014Medicare NSC