MEDICARE: DR. ROBERT THOMAS STOCKFISCH M.D.

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	2084P0800X	Psychiatry Physician	052091	GA

General Provider Information

NPI Number	:	1962747360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THOMAS STOCKFISCH M.D.

Provider Business Mailing Address
First Line	:	42 N PORT ROYAL DR
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3927
Country	:	US
Telephone Number	:	843-682-4032
Fax Number	:	843-682-4032

Provider Business Practice Location Address
First Line	:	200 GULFSTREAM RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-9677
Country	:	US
Telephone Number	:	912-965-6292
Fax Number	:	912-966-6367

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

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/11/2012

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