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NPI Code Detail

MEDICARE: MR. ROBERT ANDREW KILLOUGH P.A.-C

MEDICARE: MR. ROBERT ANDREW KILLOUGH P.A.-C
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
1363A00000XPhysician Assistant2397GA

General Provider Information

NPI Number : 1346396462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT ANDREW KILLOUGH P.A.-C
Provider Business Mailing Address
First Line : 4424 HUGH HOWELL RD STE D
Second Line :
City : TUCKER
State : GA
Zip : 30084-4905
Country : US
Telephone Number :
Fax Number : 415-252-7176
Provider Business Practice Location Address
First Line : 4424 HUGH HOWELL RD STE D
Second Line :
City : TUCKER
State : GA
Zip : 30084-4905
Country : US
Telephone Number : 404-692-4466
Fax Number : 415-252-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 04/23/2025

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