Provider Demographics
NPI:1285818567
Name:ROBERSON-DUNN, NATISHA LATRISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATISHA
Middle Name:LATRISE
Last Name:ROBERSON-DUNN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NATISHA
Other - Middle Name:LATRISE
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6047
Mailing Address - Country:US
Mailing Address - Phone:770-304-3932
Mailing Address - Fax:
Practice Address - Street 1:195 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2722
Practice Address - Country:US
Practice Address - Phone:770-507-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical