Provider Demographics
NPI:1811936891
Name:BURKICH, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:BURKICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 COBB PKWY
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-8566
Mailing Address - Country:US
Mailing Address - Phone:706-891-1200
Mailing Address - Fax:706-891-1202
Practice Address - Street 1:148 COBB PKWY
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-8566
Practice Address - Country:US
Practice Address - Phone:706-891-1200
Practice Address - Fax:706-891-1202
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046372208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700685OtherMEDICARE PTAN
GAG37644Medicare UPIN
GAGRP7800Medicare PIN