1679616072 NPI number — AUGUSTA PODIATRY ASSOCIATES

Table of content: ROBERT IRA GELB M.D. (NPI 1710079314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679616072 NPI number — AUGUSTA PODIATRY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUGUSTA PODIATRY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679616072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2030 WALTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-738-1925
Provider Business Mailing Address Fax Number:
706-738-0705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 WALTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-738-1925
Provider Business Practice Location Address Fax Number:
706-738-0705
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CREWSONBERRY
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
ROSIER
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
706-738-1925

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  POD000710 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CI4591 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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