Provider Demographics
NPI:1114072188
Name:OBST, ROBERT DANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:OBST
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2890 LAUREL GREEN CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2493
Mailing Address - Country:US
Mailing Address - Phone:770-399-9299
Mailing Address - Fax:770-399-5499
Practice Address - Street 1:1 GLENLAKE PKWY NE
Practice Address - Street 2:SUITE 1045
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3448
Practice Address - Country:US
Practice Address - Phone:770-399-9299
Practice Address - Fax:770-399-5499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist