Provider Demographics
NPI:1962674176
Name:ROBERTS, BILLY EDWARD (PA)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1101 OCILLA ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2207
Mailing Address - Country:US
Mailing Address - Phone:912-384-1900
Mailing Address - Fax:912-383-5667
Practice Address - Street 1:1101 OCILLA RD STE A
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2207
Practice Address - Country:US
Practice Address - Phone:912-384-0600
Practice Address - Fax:912-384-0601
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000904363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904OtherMEDICAL LICENSE