Provider Demographics
NPI:1932294170
Name:ROBERTS, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 PLAZA AVENUE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023
Mailing Address - Country:US
Mailing Address - Phone:478-374-9767
Mailing Address - Fax:478-374-9769
Practice Address - Street 1:917 PLAZA AVENUE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023
Practice Address - Country:US
Practice Address - Phone:478-374-9767
Practice Address - Fax:478-374-9769
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00845831AMedicaid
GA00845831AMedicaid
H06308Medicare UPIN