Provider Demographics
NPI:1255315016
Name:NAGUSZEWSKI, ROBERT K (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:NAGUSZEWSKI
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 1:119 AMBULANCE DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3856
Mailing Address - Country:US
Mailing Address - Phone:770-838-8787
Mailing Address - Fax:
Practice Address - Street 1:905 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4417
Practice Address - Country:US
Practice Address - Phone:770-812-5831
Practice Address - Fax:770-812-5832
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0327922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0004296684Medicaid
GA00429668CMedicaid
GAE71276Medicare UPIN
GA0004296684Medicaid
GA00429668CMedicaid