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General NPI Number Information
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NPI Number | 1962747360
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Entity Type | Individual
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Provider Name | ROBERT THOMAS STOCKFISCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 200 GULFSTREAM RD
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City | GARDEN CITY
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State | GA
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Zip | 31408-9677
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Country | US
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Telephone | 912-965-6292
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Fax | 912-966-6367
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Provider Business Mailing Address
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Address Line | 42 N PORT ROYAL DR
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29928-3927
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Country | US
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Telephone | 843-682-4032
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Fax | 843-682-4032
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 052091
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License Number State | GA
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