Healthcare Provider Details

I. General information

NPI: 1821066093
Provider Name (Legal Business Name): ROBERT T PERRY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 PARK DR
GREENSBORO GA
30642-3465
US

IV. Provider business mailing address

RR 1 BOX 737
SPARTA GA
31087-9753
US

V. Phone/Fax

Practice location:
  • Phone: 706-453-4945
  • Fax: 706-453-2954
Mailing address:
  • Phone: 706-453-4945
  • Fax: 706-453-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number001519
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: