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General NPI Number Information
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NPI Number | 1053321513
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Entity Type | Individual
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Provider Name | ROBERTO SPRINGER PA
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 655 7TH ST BLDG 700700-A 78 MDG/XXX
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City | ROBINS AFB
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State | GA
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Zip | 31098-2227
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Country | US
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Telephone | 706-372-6102
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Fax | 706-372-6102
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Provider Business Mailing Address
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Address Line | 1021 CHESTNUT LN RD
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City | ATHENS
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State | GA
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Zip | 30606-6214
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Country | US
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Telephone | 706-372-6102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003709
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003709
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License Number State | GA
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