Provider Demographics
NPI:1518963388
Name:PEREIRA, ROBERTO F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:F
Last Name:PEREIRA
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 1:220 J L WHITE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4893
Mailing Address - Country:US
Mailing Address - Phone:706-253-8001
Mailing Address - Fax:706-253-8002
Practice Address - Street 1:220 J L WHITE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4893
Practice Address - Country:US
Practice Address - Phone:706-253-8001
Practice Address - Fax:706-253-8002
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-04-24
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
GA058303207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I061125Medicare PIN
GA985859989FGHIKLMNOMedicaid
GAG86318Medicare UPIN