Provider Demographics
NPI:1588753719
Name:GADLAGE, ROBERT ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARTHUR
Last Name:GADLAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD STE 420
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8030
Mailing Address - Country:US
Mailing Address - Phone:770-495-1955
Mailing Address - Fax:770-232-9961
Practice Address - Street 1:3855 PLEASANT HILL RD STE 420
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8030
Practice Address - Country:US
Practice Address - Phone:770-495-1955
Practice Address - Fax:770-232-9961
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA015766174400000X
GA15766207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000069979GMedicaid
GA04BDCKXMedicare ID - Type Unspecified