Provider Demographics
NPI:1104822964
Name:HEATH, ROBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:HEATH
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 1:179 W DYKES ST
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-6921
Mailing Address - Country:US
Mailing Address - Phone:478-934-8200
Mailing Address - Fax:478-934-8244
Practice Address - Street 1:179 W DYKES ST
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-6921
Practice Address - Country:US
Practice Address - Phone:478-934-8200
Practice Address - Fax:478-934-8244
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000682404DMedicaid
GAG18827Medicare UPIN
GA11BDPQKMedicare ID - Type Unspecified