Provider Demographics
NPI:1043372444
Name:WALDROP, ROBERT CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:WALDROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6300 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1828
Mailing Address - Country:US
Mailing Address - Phone:770-454-4685
Mailing Address - Fax:770-454-4690
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1828
Practice Address - Country:US
Practice Address - Phone:770-454-4685
Practice Address - Fax:770-454-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0456572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG71170Medicare UPIN
GA13BDDKBMedicare ID - Type Unspecified