Provider Demographics
NPI:1982838975
Name:ROBERTSON, TAMI CARBY (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:CARBY
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 BARRETT PKWY STE 158
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4952
Mailing Address - Country:US
Mailing Address - Phone:770-429-1660
Mailing Address - Fax:
Practice Address - Street 1:3155 COBB PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5535
Practice Address - Country:US
Practice Address - Phone:770-644-0012
Practice Address - Fax:770-644-0091
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7349T152W00000X
GAOPT 002651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist