Provider Demographics
NPI:1346227410
Name:CARGILE, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CARGILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:MICHAEL
Other - Last Name:CARGILE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10166 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5118
Mailing Address - Country:US
Mailing Address - Phone:706-579-1614
Mailing Address - Fax:706-579-1617
Practice Address - Street 1:10166 BIG CANOE
Practice Address - Street 2:
Practice Address - City:BIG CANOE
Practice Address - State:GA
Practice Address - Zip Code:30143-5118
Practice Address - Country:US
Practice Address - Phone:706-579-1614
Practice Address - Fax:706-579-1617
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034310207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00532287CMedicaid
GA93BDSSNMedicare ID - Type Unspecified
GA00532287CMedicaid