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NPI Code Detail

MEDICARE: ROBERT LEWIS STICKLE MD

MEDICARE: ROBERT LEWIS STICKLE MD
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
12085R0202XDiagnostic Radiology Physician102976GA
22085R0202XDiagnostic Radiology Physician11928RI

Other Identifiers

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

General Provider Information

NPI Number : 1255320685
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT LEWIS STICKLE MD
Provider Business Mailing Address
First Line : 700 E MOREHEAD ST STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28202-2742
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2624 DAWSON RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-1609
Country : US
Telephone Number : 229-888-1624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 03/05/2025

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