Basic Information
| Provider Information | |||||||||
| NPI: | 1982838975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | TAMI | ||||||||
| MiddleName: | CARBY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 BARRETT PKWY STE 158 | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301444952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704291660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3155 COBB PKWY SE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303395535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706440012 | ||||||||
| FaxNumber: | 7706440091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 02/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7349T | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPT 002651 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.