Healthcare Provider Details

I. General information

NPI: 1992786818
Provider Name (Legal Business Name): ROBERT DAVID GATLIFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 WASHINGTON AVE
SANDERSVILLE GA
31082-1971
US

IV. Provider business mailing address

528 WASHINGTON AVE
SANDERSVILLE GA
31082-1971
US

V. Phone/Fax

Practice location:
  • Phone: 478-240-2070
  • Fax: 478-370-2501
Mailing address:
  • Phone: 478-240-2070
  • Fax: 478-370-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number064035
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: