MEDICARE: ROBERT T PERRY PA

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	207Q00000X	Family Medicine Physician	001519	GA

General Provider Information

NPI Number	:	1821066093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT T PERRY PA

Provider Business Mailing Address
First Line	:	RR 1 BOX 737
Second Line	:
City	:	SPARTA
State	:	GA
Zip	:	31087-9753
Country	:	US
Telephone Number	:	706-453-4945
Fax Number	:	706-453-2954

Provider Business Practice Location Address
First Line	:	1041 PARK DR
Second Line	:
City	:	GREENSBORO
State	:	GA
Zip	:	30642-3465
Country	:	US
Telephone Number	:	706-453-4945
Fax Number	:	706-453-2954

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/28/2014

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Directions to “ ROBERT T PERRY PA” Practice Location

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