Healthcare Provider Details

I. General information

NPI: 1316940547
Provider Name (Legal Business Name): ROBERT GLEN BASHUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CENTURY PKWY NE
ATLANTA GA
30345-3154
US

IV. Provider business mailing address

2200 CENTURY PKWY NE STE 260
ATLANTA GA
30345-3103
US

V. Phone/Fax

Practice location:
  • Phone: 404-946-9327
  • Fax: 833-941-2436
Mailing address:
  • Phone: 404-946-9327
  • Fax: 833-941-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number026451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: