Provider Demographics
NPI:1437150455
Name:WEATHERSTONE, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:WEATHERSTONE
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 9046
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9046
Mailing Address - Country:US
Mailing Address - Phone:706-320-2766
Mailing Address - Fax:706-320-2768
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE A201
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-320-2766
Practice Address - Fax:706-320-2768
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026814207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I105894OtherMEDICARE PTAN
GA000370444Medicaid