Demetrise Roberts
Driver in Mcdonough, GA. Individual provider (NPI-1).
NPI number1154976868
StatusActive
Last updated in NPPESAug 8, 2019
Details
- NPI
- 1154976868
- Entity type
- Individual (NPI-1)
- Name
- Demetrise Roberts
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 8, 2019
- Last updated
- Aug 8, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 172A00000X | Driver | – | – | Yes |
Practice location
2141 Dartmouth CtMcdonough, GA 30253-6884
Phone 404-759-6480
Mailing address
2141 Dartmouth CtMcdonough, GA 30253-6884
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