=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417117623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT G. PALERINO, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2008
-----------------------------------------------------
Last Update Date | 08/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 ENTERPRISE CT SUITE B
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-9227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-257-9998
-----------------------------------------------------
Fax | 706-257-9993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 ENTERPRISE CT SUITE B
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-9227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-257-9998
-----------------------------------------------------
Fax | 706-257-9993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. ROBERT G PALERINO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 706-257-9998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------