Provider Demographics
NPI:1760070395
Name:ROBERTS, GEORGE VINCENT (CNP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:VINCENT
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1224
Mailing Address - Country:US
Mailing Address - Phone:404-219-6094
Mailing Address - Fax:
Practice Address - Street 1:511 W GROVE ST STE 105
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:508-923-3427
Practice Address - Fax:508-923-3428
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272276363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health