Provider Demographics
NPI:1093870313
Name:PYLE, ROBERT CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLINTON
Last Name:PYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:14 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-4381
Practice Address - Country:US
Practice Address - Phone:770-749-9600
Practice Address - Fax:770-749-9628
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000722334KMedicaid
G41360Medicare UPIN
GA000722334KMedicaid