Provider Demographics
NPI:1568576866
Name:DEIMLER, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DEIMLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 934915
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4915
Mailing Address - Country:US
Mailing Address - Phone:404-501-7969
Mailing Address - Fax:404-501-3874
Practice Address - Street 1:3555 CENTERVILLE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6456
Practice Address - Country:US
Practice Address - Phone:770-985-9957
Practice Address - Fax:770-985-9959
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080087199OtherRAIL ROAD MEDICARE
4478304OtherAETNA
581816OtherBLUE CROSS BLUE SHIELD
GA00616261BMedicaid
E63578Medicare UPIN
GA00616261BMedicaid