Healthcare Provider Details

I. General information

NPI: 1639148224
Provider Name (Legal Business Name): ROBERT B RHOADES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 W WHEELER PKWY
AUGUSTA GA
30909-1899
US

IV. Provider business mailing address

1219 W WHEELER PKWY
AUGUSTA GA
30909-1899
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-1520
  • Fax:
Mailing address:
  • Phone: 706-855-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number13420
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number013420
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number013420
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13420
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: