Provider Demographics
NPI:1417948282
Name:PACKER, ROBERT M III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:PACKER
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:711 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-1943
Mailing Address - Country:US
Mailing Address - Phone:912-283-9423
Mailing Address - Fax:912-283-8204
Practice Address - Street 1:711 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1943
Practice Address - Country:US
Practice Address - Phone:912-283-9423
Practice Address - Fax:912-283-8204
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA18716207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACG6045OtherRAILROAD MEDICARE GROUP ID
GA1417948282OtherMEDICARE NPI
GA000151665CMedicaid
GA202I119933Medicare PIN