Provider Demographics
NPI:1568480051
Name:CUSHNER, ROBERT WILLIAM (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:CUSHNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1106
Mailing Address - Country:US
Mailing Address - Phone:912-489-8727
Mailing Address - Fax:912-764-7882
Practice Address - Street 1:95 BEL AIR DRIVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461
Practice Address - Country:US
Practice Address - Phone:912-489-8727
Practice Address - Fax:912-764-7882
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000476213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00213221A 00213221BMedicaid
T97527Medicare UPIN