Healthcare Provider Details

I. General information

NPI: 1649299546
Provider Name (Legal Business Name): ROBERT A GROVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST HOSPITAL DRIVE DEPARTMENT OB/GYN
FORT GORDON GA
90905
US

IV. Provider business mailing address

300 E HOSPITAL ROAD
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-7228
  • Fax:
Mailing address:
  • Phone: 706-787-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number86864
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: