Gina Williams Roberts, DDS
Individual provider Active NPI General Practice Dentistry · Hazlehurst, GA
NPI 1861601882 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1861601882
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 10748 (GA)
- Practice address
- 92 S Tallahassee St
Hazlehurst, GA 31539-6157 - Phone
- (912) 375-4531
- Fax
- (912) 375-4532
- NPI assigned
- May 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gina W Roberts | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10748 | GA | Yes |
Addresses
Primary practice location
92 S Tallahassee St
Hazlehurst, GA 31539-6157
Mailing address
PO Box 1300
Hazlehurst, GA 31539-1300
Phone (912) 375-4531
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00386636B | Medicaid | GA |
Other providers in Hazlehurst, GA
- Bonnie Pittman
- Ramay Pharmacy, LLC
- David A Ray
- Giselle Reddy
- Melissa Suzanne Register
- John J Rogers
- Jerri-Ann Rowell
- Rural Urgent Care LLC
- Scott J Waguespack MD/Family Healthcare
- Sara Ellen Sears
All providers in Hazlehurst, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.