Provider Demographics
NPI:1609255520
Name:ROBY, NETA J (NPC)
Entity Type:Individual
Prefix:MRS
First Name:NETA
Middle Name:J
Last Name:ROBY
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 SILVER SPUR DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6127
Mailing Address - Country:US
Mailing Address - Phone:770-482-2535
Mailing Address - Fax:
Practice Address - Street 1:HWY 36
Practice Address - Street 2:GEORGIA DIAGNOSTIC CLASSIFICATION PRISON
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233
Practice Address - Country:US
Practice Address - Phone:770-504-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095299363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health