Provider Demographics
NPI:1033149091
Name:SNODDY, ROBERT O'NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O'NEIL
Last Name:SNODDY
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 1:610 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1528
Mailing Address - Country:US
Mailing Address - Phone:706-322-7884
Mailing Address - Fax:706-660-2167
Practice Address - Street 1:610 19TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1528
Practice Address - Country:US
Practice Address - Phone:706-322-7884
Practice Address - Fax:706-660-2167
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BDJKWMedicare PIN
GAF76392Medicare UPIN