Provider Demographics
NPI:1194934703
Name:BOSTICK, ROBERD MANER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERD
Middle Name:MANER
Last Name:BOSTICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:OF EPIDEMIOLOGY
Mailing Address - Street 2:1518 CLIFTON ROAD NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4201
Mailing Address - Country:US
Mailing Address - Phone:404-727-2671
Mailing Address - Fax:404-727-8737
Practice Address - Street 1:OF EPIDEMIOLOGY
Practice Address - Street 2:1518 CLIFTON ROAD NE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4201
Practice Address - Country:US
Practice Address - Phone:404-727-2671
Practice Address - Fax:404-727-8737
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31896OtherSTATE MED. LIC. NO.
NC9401136OtherSTATE MED. LIC. NO.
GA057435OtherSTATE MED. LIC. NO.
SC8373OtherSTATE MED. LIC. NO.
SC8373OtherSTATE MED. LIC. NO.
NC9401136OtherSTATE MED. LIC. NO.