Provider Demographics
NPI:1538702253
Name:ROBERSON, TIARA
Entity Type:Individual
Prefix:MS
First Name:TIARA
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:AVRIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3059 QUANTUM LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-8100
Mailing Address - Country:US
Mailing Address - Phone:404-337-4570
Mailing Address - Fax:
Practice Address - Street 1:3059 QUANTUM LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-8100
Practice Address - Country:US
Practice Address - Phone:404-337-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH010369253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care