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General NPI Number Information
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NPI Number | 1598858615
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Entity Type | Individual
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Provider Name | ROBERT BUMGARDNER NP
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 3080 HIGHLANDS PKWY SE
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City | SMYRNA
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State | GA
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Zip | 30082-5181
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Country | US
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Telephone | 770-540-7942
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Fax |
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Provider Business Mailing Address
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Address Line | 920 2ND AVE S STE 400
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-3318
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Country | US
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Telephone | 612-659-7111
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN135809 NP
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License Number State | GA
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