Healthcare Provider Details

I. General information

NPI: 1245279009
Provider Name (Legal Business Name): ROBERT A FORBES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 DALLAS HWY SW STE 300
MARIETTA GA
30064-6426
US

IV. Provider business mailing address

3405 DALLAS HWY SW STE 300
MARIETTA GA
30064-6426
US

V. Phone/Fax

Practice location:
  • Phone: 770-425-5331
  • Fax: 770-425-0799
Mailing address:
  • Phone: 770-425-5331
  • Fax: 770-425-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number034341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: