Provider Demographics
NPI:1528571742
Name:ROBERTSON, DANIEL OLIVER (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:OLIVER
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:2555 COURT DR STE 450
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2191
Practice Address - Country:US
Practice Address - Phone:046-717-6527
Practice Address - Fax:704-671-7656
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2024-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-07638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant