MEDICARE: DR. ROBERT P BRISSETT DPM

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	213E00000X	Podiatrist	POD000950	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	:	1912999004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT P BRISSETT DPM

Provider Business Mailing Address
First Line	:	5124 GROVE FIELD PT
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-2387
Country	:	US
Telephone Number	:	678-994-8674
Fax Number	:	866-678-9749

Provider Business Practice Location Address
First Line	:	5124 GROVE FIELD PT
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-2387
Country	:	US
Telephone Number	:	678-994-8674
Fax Number	:	866-678-9749

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/01/2017

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