MEDICARE: DR. ROBERT A DECOLLI JR. D.O

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	207R00000X	Internal Medicine Physician	4200	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110104720	OTHER	PA	RAILROAD MEDICARE

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	:	1790778991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A DECOLLI JR. D.O

Provider Business Mailing Address
First Line	:	PO BOX 746725
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6725
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	3360 N WATKINS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-6405
Country	:	US
Telephone Number	:	901-401-7150
Fax Number	:	901-347-1285

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	12/22/2025

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