Provider Demographics
NPI:1285219477
Name:ROBERTS, SAMUEL PAUL (PA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PAUL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:404-446-0600
Mailing Address - Fax:404-446-0601
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Practice Address - Street 2:SUITE 290
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:404-446-0600
Practice Address - Fax:404-446-0601
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2024-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA10401363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical