Healthcare Provider Details

I. General information

NPI: 1134039092
Provider Name (Legal Business Name): ROBERT LUDWIG III
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 JOE FRANK HARRIS PKWY SE STE 100
CARTERSVILLE GA
30120-2160
US

IV. Provider business mailing address

275 INTERSTATE NORTH CIR SE STE 500
ATLANTA GA
30339-2565
US

V. Phone/Fax

Practice location:
  • Phone: 770-445-5666
  • Fax: 770-445-0799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: