Provider Demographics
NPI:1346396462
Name:KILLOUGH, ROBERT ANDREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANDREW
Last Name:KILLOUGH
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 HUGH HOWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:4424 HUGH HOWELL RD STE D
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4905
Practice Address - Country:US
Practice Address - Phone:404-692-4466
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant