Active NPI
Aretha J Roberson, PA-C
- Physician Assistant
- Austell, GA
National Provider Identifier
1982910238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5969
- Practice address
- 3950 Austell Rd
Austell, GA 30106-1121 - Phone
- (770) 732-5000
- NPI assigned
- Aug 24, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5969 | GA | Primary |
Addresses
Primary practice location
3950 Austell Rd
Austell, GA 30106-1121
Mailing address
5665 New Northside Dr NW
Suite 320
Atlanta, GA 30328-5831
Phone (770) 874-5468
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5969 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331596800000",
"number": "1982910238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5665 NEW NORTHSIDE DR NW",
"address_2": "SUITE 320",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303285831",
"telephone_number": "770-874-5468",
"fax_number": "770-874-5469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 AUSTELL RD",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061121",
"telephone_number": "770-732-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERSON",
"first_name": "ARETHA",
"middle_name": "J",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-24",
"last_updated": "2012-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "5969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.