Healthcare Provider Details

I. General information

NPI: 1366448086
Provider Name (Legal Business Name): ROBERT A ZECCHINI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3862
US

IV. Provider business mailing address

1240 JESSE JEWELL PKWY SE SUITE 500
GAINESVILLE GA
30501-3862
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-9864
  • Fax: 770-297-5012
Mailing address:
  • Phone: 770-536-9864
  • Fax: 770-297-5012

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: