Provider Demographics
NPI:1235362914
Name:GARY A ROBERSON PLLC
Entity Type:Organization
Organization Name:GARY A ROBERSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-201-5009
Mailing Address - Street 1:4209 LAKELAND DR
Mailing Address - Street 2:STE 240
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9212
Mailing Address - Country:US
Mailing Address - Phone:601-951-9863
Mailing Address - Fax:601-487-8897
Practice Address - Street 1:797 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-5132
Practice Address - Country:US
Practice Address - Phone:601-201-5009
Practice Address - Fax:601-487-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty