Provider Demographics
NPI:1538522339
Name:ROBERTS, EUGENE ALPHONSA SR
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:ALPHONSA
Last Name:ROBERTS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 16TH CT
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3874
Mailing Address - Country:US
Mailing Address - Phone:706-573-8680
Mailing Address - Fax:
Practice Address - Street 1:2503 16TH CT
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3874
Practice Address - Country:US
Practice Address - Phone:706-573-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker