Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 045657 | GA |
NPI | 1043372444 |
---|---|
Provider Name | Dr. Robert Carl Waldrop |
First Address | Johns Creek, GA 30097-1828 |
Second Address | Johns Creek, GA 30097-1828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71170 | (02) | GA |