Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 048046 | GA |
N | 207PE0004X | Emergency Medical Services | 048046 | GA |
N | 207PP0204X | Pediatric Emergency Physician | 048046 | GA |
N | 207Q00000X | Family Doctor | 048046 | GA |
N | 207QA0505X | Family Doctor - Adult Medicine | 048046 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 048046 | GA |
N | 207QS0010X | Family Doctor - Sports Medicine | 048046 | GA |
NPI | 1518998210 |
---|---|
Provider Name | Dr. Robert P Garnett JR. |
First Address | Augusta, GA 30904-4480 |
Second Address | Augusta, GA 30909-6521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10062907 | AMERIGROUP (01) | |
1447352778 | NPI - CSRA EMERGENCY PHYS (01) | |
345597 | WELLCARE OF GA (01) | |
I54689 | (02) |