Provider Demographics
NPI:1215973631
Name:CULVER, ROBERT LEE JR (PAA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:CULVER
Suffix:JR
Gender:M
Credentials:PAA
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:LEE
Other - Last Name:CULVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 516
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2313
Mailing Address - Country:US
Mailing Address - Phone:404-219-4483
Mailing Address - Fax:770-921-1687
Practice Address - Street 1:620 PEACHTREE ST NE
Practice Address - Street 2:SUITE 516
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2313
Practice Address - Country:US
Practice Address - Phone:404-219-4483
Practice Address - Fax:770-921-1687
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002849367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000999AMedicaid
GA100000999JMedicaid
GA511I970558Medicare PIN
GA511I320015Medicare PIN