Active NPI
Maurice Levitas Robertson
- Other Technician
- College Park, GA
National Provider Identifier
1497955991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 4001-0107-0559-828
- Practice address
- 2860 Keenan Rd
College Park, GA 30349-4640 - Phone
- (770) 996-4491
- NPI assigned
- Jul 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 4001-0107-0559-828 | GA | Primary |
Addresses
Primary practice location
2860 Keenan Rd
College Park, GA 30349-4640
Mailing address
2860 Keenan Rd
College Park, GA 30349-4640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4001-0107-0559-828 | GA | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185148800000",
"number": "1497955991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2860 KEENAN RD",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303494640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2860 KEENAN RD",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303494640",
"telephone_number": "770-996-4491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "MAURICE",
"middle_name": "LEVITAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-23",
"last_updated": "2007-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "GA",
"license": "4001-0107-0559-828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.