Healthcare Provider Details

I. General information

NPI: 1912902438
Provider Name (Legal Business Name): ROBERT KEITH SHULER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

105 COLLIER RD NW STE 4060
ATLANTA GA
30309-1765
US

IV. Provider business mailing address

105 COLLIER RD NW STE 4060
ATLANTA GA
30309-1765
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-6662
  • Fax: 404-351-6030
Mailing address:
  • Phone: 404-351-6662
  • Fax: 404-351-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number009253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: