Provider Demographics
NPI:1134498967
Name:DUKE, ROBERT JOSEPH
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:DUKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PARKLAKE DR NE
Mailing Address - Street 2:APT 1007
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2898
Mailing Address - Country:US
Mailing Address - Phone:678-361-6603
Mailing Address - Fax:
Practice Address - Street 1:3826 COBB PARKWAY N
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4022
Practice Address - Country:US
Practice Address - Phone:770-966-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHI-014835390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program