Provider Demographics
NPI:1659709640
Name:ROBERTS, MICHELE G (OD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:G
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:G
Other - Last Name:MARZELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:524 MONARCH LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7795
Mailing Address - Country:US
Mailing Address - Phone:347-756-2349
Mailing Address - Fax:
Practice Address - Street 1:1862 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5960
Practice Address - Country:US
Practice Address - Phone:678-432-1584
Practice Address - Fax:678-432-6258
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist