MEDICARE: ROBERT A. UNDERWOOD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	049950	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063570521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A. UNDERWOOD M.D.

Provider Business Mailing Address
First Line	:	598 NANCY ST NW STE 250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1377
Country	:	US
Telephone Number	:	770-428-3713
Fax Number	:	770-426-0730

Provider Business Practice Location Address
First Line	:	598 NANCY ST NW STE 250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1377
Country	:	US
Telephone Number	:	770-428-3713
Fax Number	:	770-426-0730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/01/2018

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