Provider Demographics
NPI:1104823160
Name:GELLER, ROBERT JEROME (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEROME
Last Name:GELLER
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 1:49 JESSE HILL JR DR SE
Mailing Address - Street 2:EMORY UNIV DEPT PEDIATRICS
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3049
Mailing Address - Country:US
Mailing Address - Phone:404-616-6652
Mailing Address - Fax:404-616-6657
Practice Address - Street 1:49 JESSE HILL JR DR SE
Practice Address - Street 2:EMORY UNIV DEPT PEDIATRICS
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3049
Practice Address - Country:US
Practice Address - Phone:404-616-6652
Practice Address - Fax:404-616-6657
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030771208000000X, 2080T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00369432AMedicaid
GA00369432AMedicaid