Provider Demographics
NPI:1821015355
Name:ROBERTS, ASHLEY JEAN (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 RIVERBEND CLUB DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2802
Mailing Address - Country:US
Mailing Address - Phone:770-980-1618
Mailing Address - Fax:
Practice Address - Street 1:1022 RIVERBEND CLUB DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2802
Practice Address - Country:US
Practice Address - Phone:770-980-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0012272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer