Provider Demographics
NPI:1356440853
Name:STAHLKUPPE, ROBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:STAHLKUPPE
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 409
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-0409
Mailing Address - Country:US
Mailing Address - Phone:706-896-2289
Mailing Address - Fax:706-896-6007
Practice Address - Street 1:56 HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546
Practice Address - Country:US
Practice Address - Phone:706-896-2289
Practice Address - Fax:706-896-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000195665GMedicaid
NC8906720Medicaid
D30891Medicare UPIN
GA000195665GMedicaid