Provider Demographics
NPI:1386912475
Name:PHILIP K. ROBB, M.D., PC
Entity type:Organization
Organization Name:PHILIP K. ROBB, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-410-0202
Mailing Address - Street 1:3400 OLD MILTON PARKWAY
Mailing Address - Street 2:BLDG C STE 575
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4438
Mailing Address - Country:US
Mailing Address - Phone:770-410-0202
Mailing Address - Fax:770-410-0995
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:BLDG C STE 575
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-410-0202
Practice Address - Fax:770-410-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF09579Medicare UPIN