Natisha Latrise Roberson-Dunn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004412 Issued in GA

Practice address

195 Fairview Rd
Ellenwood, GA 30294-2722

Phone

(770) 507-0112

NPI assigned

Dec 22, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Natisha Latrise Roberson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198281600000",
    "number": "1285818567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 COBBLESTONE DR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656047",
            "telephone_number": "770-304-3932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 FAIRVIEW RD",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942722",
            "telephone_number": "770-507-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON-DUNN",
        "first_name": "NATISHA",
        "middle_name": "LATRISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-22",
        "last_updated": "2007-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NATISHA",
            "last_name": "ROBERSON",
            "middle_name": "LATRISE",
            "prefix": "MISS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Medical Physician Assistant in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.