Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 034341 | GA |
NPI | 1245279009 |
---|---|
Provider Name | Dr. Robert A Forbes JR. |
First Address | Marietta, GA 30064-6426 |
Second Address | Marietta, GA 30064-6426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 03/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000811588B | (05) | GA |
000811588C | (05) | GA |
000811588D | (05) | GA |