Provider Demographics
NPI:1114985249
Name:DUVALL, ROBERT EMERSON (PT DHSC MMSC OCS FAA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMERSON
Last Name:DUVALL
Suffix:
Gender:M
Credentials:PT DHSC MMSC OCS FAA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2138 SCENIC HWY
Mailing Address - Street 2:STE B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-979-1400
Mailing Address - Fax:770-978-0974
Practice Address - Street 1:2138 SCENIC HWY
Practice Address - Street 2:STE B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-979-1400
Practice Address - Fax:770-978-0974
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679780092OtherFACILITY NPI
GAGRP8088Medicare PIN