MEDICARE: DR. ROBERT DANIEL OBST PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	915	GA

General Provider Information

NPI Number	:	1114072188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DANIEL OBST PSYD

Provider Business Mailing Address
First Line	:	2890 LAUREL GREEN CT
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-2493
Country	:	US
Telephone Number	:	770-399-9299
Fax Number	:	770-399-5499

Provider Business Practice Location Address
First Line	:	1 GLENLAKE PKWY NE
Second Line	:	SUITE 1045
City	:	ATLANTA
State	:	GA
Zip	:	30328-3448
Country	:	US
Telephone Number	:	770-399-9299
Fax Number	:	770-399-5499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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