Provider Demographics
NPI:1275504359
Name:KAEMMERLEN, ROBERT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:KAEMMERLEN
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:840 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1845
Practice Address - Country:US
Practice Address - Phone:864-489-3300
Practice Address - Fax:864-488-3744
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4571262OtherAETNA
SCSC7632J577OtherMEDICARE PIN
NC890518IMedicaid
SC26185OtherMEDCOST
SCB916606121OtherMEDICARE PIN
SC102310Medicaid
SCSC76326067OtherMEDICARE PIN
SC4571262OtherAETNA
SCB91660Medicare UPIN
SCB91660Medicare PIN