Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Marilyn Nichole Moulton Roberts, PA-C

Individual provider Physician Assistant · NPI 1811463490

Marilyn Nichole Moulton Roberts, PA-C is a Physician Assistant in Columbus, Georgia. Graduated from University of South Alabama College of Medicine in 2018, 8 years ago. Practices with Lane Dermatology and Dermatologic Surgery LLC, a 7-clinician group and accepts Medicare assignment. Licensed in Alabama.

Years since qualifying
8
Trained at
University of South Alabama College of Medicine
Licensed in
AL
In the registry since
2018
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1210 Brookstone Centre Pkwy
Columbus, GA 31904-9272
Phone: (706) 322-1717
Fax: (706) 322-1718
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1404 (AL)

Record details

NPI number1811463490
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 22, 2018
Last updated in NPPESApril 13, 2023
Certification dateApril 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolUNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Graduated 2018 (8 years in practice)
Group practice Lane Dermatology And Dermatologic Surgery Llc — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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